title: Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation.
abstract: OBJECTIVE
  Computed tomography (CT) has been suggested as an aid or even a replacement for autopsy. The aim of this trial was to study the conformity of the two methods in finding injuries in non-surviving patients after unsuccessful cardiopulmonary resuscitation.
  
  
  METHODS
  In this prospective study, 31 patients were submitted to a CT prior to autopsy after unsuccessful resuscitation attempts. Pathological findings were noted by both the radiologist and the pathologists in a specified protocol. The pathologists and radiologist were blinded from each other's results.
  
  
  RESULTS
  CT and autopsy revealed rib fractures in 22 and 24 patients respectively (kappa=0.83). In 8 patients, CT revealed more rib fractures than autopsy; and in 12 patients, autopsy revealed more rib fractures than CT. In 7 patients, neither method showed any rib fractures. The mean difference between the two methods in detecting rib fractures was 0.16 (S.D.: ± 3.174, limits of agreement: -6.19 to 6.51). The kappa value for sternal fractures was 0.49. A total of 260 pathological findings were noted by CT and 244 by autopsy. The average patient showed a median of 9 injuries (every fracture counted as one injury), independent of the method used in detecting the injuries.
  
  
  CONCLUSIONS
  There was a strong concordance between the two methods in finding rib fractures but not sternal fractures and these results support the concept of CT as a valuable complement to autopsy in detecting rib fractures after unsuccessful cardiopulmonary resuscitation but not as a replacement. Other injuries did not show the same concordance.
authors: Department of Surgical Sciences - Anaesthesiology & Intensive Care, Uppsala University, S-751 85 Uppsala, Sweden. dsmekal@gmail.com
authors: David
authors: D
authors: Smekal
authors: Tomas
authors: T
authors: Hansen
authors: Håkan
authors: H
authors: Sandler
authors: Sten
authors: S
authors: Rubertsson
mesh_terms: D001344:Autopsy / Q000379:methods*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods; D015203:Reproducibility of Results; D012253:Rib Fractures / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices