title: Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice.
abstract: BACKGROUND
  Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities.
  
  
  OBJECTIVE
  The aim of this study was to review the diagnostic yield of this practice.
  
  
  METHODS
  We identified 1,027 cases performed in a single institution over a 2½-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness.
  
  
  RESULTS
  The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving.
  
  
  CONCLUSIONS
  Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings.
authors.affiliation: Department of Radiology Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK, owen.arthurs@gosh.nhs.uk.
authors.forename: Owen J
authors.initials: OJ
authors.lastname: Arthurs
authors.forename: Alistair D
authors.initials: AD
authors.lastname: Calder
authors.forename: Liina
authors.initials: L
authors.lastname: Kiho
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Taylor
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
mesh_terms: D001344:Autopsy / Q000191:economics* / Q000706:statistics & numerical data; D001847:Bone Diseases / Q000000981:diagnostic imaging / Q000191:economics* / Q000401:mortality*; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000191:economics* / Q000401:mortality*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D011859:Radiography / Q000191:economics*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology