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. 2025 Dec 19:110022.
doi: 10.1016/j.surg.2025.110022. Online ahead of print.

A rapid and reliable alternative to autopsy at a level I trauma center

Jessica M Delamater  1 , Gary H Danton  2 , Larisa Shagabayeva  3 , Luciana Tito Bustillos  4 , Michael D Cobler-Lichter  5 , Brianna L Collie  6 , Nicole B Lyons  7 , Brandon M Parker  6 , Paul J Wetstein  6 , Jonathan P Meizoso  8 , Nicholas Namias  9 , Kenneth G Proctor  6 , Edward B Lineen  6
Affiliations

A rapid and reliable alternative to autopsy at a level I trauma center

Jessica M Delamater et al. Surgery. .

Abstract

Background: Autopsies are the gold standard for determining traumatic deaths causes, but rates have been decreasing. Postmortem computed tomography is an alternative; however, its utility and feasibility in patients who have undergone interventions is unknown. In addition, questions remain about artifacts caused by surgical interventions and postmortem putrefaction. We hypothesized that postmortem computed tomography is a rapid, reliable, and practical alternative to trauma autopsy, even in patients who underwent invasive interventions.

Methods: All postmortem computed tomography scans at our trauma center from March 2023 to April 2024 were retrospectively reviewed and divided into those who received invasive interventions, defined as thoracostomy, thoracotomy, or laparotomy, and those who did not. Injury severity score pre- and postpostmortem computed tomography was compared between groups. postmortem computed tomography scans were reviewed to investigate missed injuries and the presence of ectopic air.

Results: In total, 54 patients received postmortem computed tomography, with a mean age of 42 ± 18 years. Most were male (78%) with blunt injury (82%). The median time from death to postmortem computed tomography was 126 minutes. Among the 25 patients (46%) who underwent invasive interventions, Injury Severity Score increased from 10 to 48 after postmortem computed tomography (P < .001). In the no-intervention group, Injury Severity Score increased similarly after postmortem computed tomography (3 vs 50, P < .001). Hepatic gas was seen in 70% and intracardiac air in 56% of patients. Time from death to postmortem computed tomography was similar in patients with and without hepatic gas and intracardiac air (P > .05).

Conclusions: Postmortem computed tomography increases Injury Severity Score in patients who received invasive interventions and can identify injuries that may be missed on autopsy, such as ectopic air, making it a rapid and reliable alternative to autopsy.

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Conflict of interest statement

Conflict of Interest/Disclosure Dr Jonathan Meizoso has received research support from CSL Behring and Takeda Pharmaceuticals. He has also received speaking honoraria from Cerus Corporation and Memorial Healthcare System. He is on the editorial board of Trauma Surgery & Acute Care Open and Journal of Surgical Research. Dr Nicholas Namias has received research grant funding from Humacyte and support from CSL Behring. He serves on the advisory boards of Eli Lilly, Merck, and Molnlycke. All other authors of this manuscript have no relevant financial disclosures.

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