Detecting the cause of death in infants and children: Whole body post-mortem computed tomography compared to autopsy.

Abstract Post-mortem investigation is a sensitive issue that needs to be studied in order to address the many issues that surround this topic. This thesis is divided into 7 chapters. Chapter One is a review of the literature, providing information about identifying the causes of death in children, autopsy protocols and the acceptability of post-mortem investigations among the public. Chapter Two determined the reaction towards post-mortem procedures among Muslims and non-Muslims in Libya and in the UK. Muslims were found to have a significant preference for post-mortem imaging compared to autopsy except in homicidal cases. Chapter Three is a systematic review of the literature which identified 3 papers totalling 262 patients and showed overall agreement between post-mortem CT and conventional autopsy of 51%. Chapter Four is an evaluation of the performance of PMCT compared to conventional autopsy in identifying the cause of death in 54 infants and children. Conventional autopsy detected significantly more abnormalities than PMCT and proved to be superior to PMCT for identifying organ’ soft tissue abnormalities. PMCT however was superior at identifying skeletal pathology. Chapter Five investigated whether longitudinal changes in organ Hounsfield units (HU) and total body air volume (TBAV) can provide an estimate of post-mortem interval (PMI) in eight euthanised lambs. TBAV increased by 14 cm3 (p< 0.001) for each additional post-mortem day with an intercept of 116 cm3 (p< 0.001). There was clear and progressive decrease in tissue densities and increase in TBAV in individual cases over time. Chapter Six is a pilot study to determine whether PMCT can be used to estimate PMI in 51 infants and children by measuring HU of selected organs. Results suggest that further investigation of the reliability of using HU of the kidney and spleen to estimate PMI is warranted. Chapter Seven provides an overview, discussion and concludes this thesis.