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though mechanical ventilation was maintained to prevent lung collapse&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The PMCT readings were interpreted by 2 independent radiologists experienced in the management of polytrauma patients&#46; The most plausible cause of death and the calculated ISS were determined in a joint clinical session between the Radiodiagnosis and Intensive Medicine services after reviewing the images and medical history&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The project was evaluated by the hospital research ethics committee with a favorable result&#44; required family consent for the analysis of the images and data obtained&#46; Since PMCT is a non-invasive imaging modality without any repercussions on the cadaver and its results can be affected by the time until it is eventually performed&#44; implicit consent was used for immediate performance after death&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We have managed 7 cases since 2022&#46; All of them were men&#44; being the most frequent injury mechanism falls &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;4&#59; 57&#37;&#41;&#44; followed by motorcycle accidents &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;2&#59; 28&#37;&#41;&#44; and gunshots &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;1&#59; 15&#37;&#41;&#46; The mean age was 46 years &#177;16&#44; and the median ISS calculated by post-mortem tomography&#44; 50 &#40;&#177;16&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The most probable cause of death was identified in 100&#37; of the patients&#44; being thoracic trauma the main contributor&#44; followed by hemorrhagic shock&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> illustrates an example of hemorrhagic shock due to a high-grade liver injury&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding medical devices&#44; they were removed in two patients prior to performing the PMCT&#46; Still&#44; we could identify the incorrect positioning of some devices in 80&#37; of the remaining cases&#44; being the most common incorrect position the inadequate placement of the endotracheal tube in relation to the carina&#46; The most severe case was the incorrect placement of 2 chest tubes in the same patient&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">There was 1 case of PM based on ISS and TRISS&#46; The results related to the cause of death&#44; associated injuries&#44; devices&#44; and PM are shown in Table 1 of the Supplementary data&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main limitation of PMCT is the identification of solid organ injuries and vascular lesions due to the absence of IV contrast and spontaneous circulation&#46; This may cause severe injuries to go unnoticed&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8</span></a> However&#44; such injuries were inferred through indirect data such as the presence of significant hemoperitoneum&#44; organ deformity&#44; or perivascular hematoma&#46; In addition&#44; indirect findings of exsanguination&#44; such as hemothorax&#47;hemoperitoneum&#44; or large injuries to vital organs incompatible with life&#44; are enough to identify the cause of death without having to pinpoint the exact bleeding site&#46; Post-mortem angiography with IV contrast would improve these results but adds complexity to the study and use of resources&#46; Additionally&#44; its clinical utility compared to PMCT without IV contrast is currently uncertain to date&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Based on this experience&#44; we believe that the use of PMCT can be an epidemiological tool to analyze the cause of death in patients who die early from trauma&#44; study PM&#44; assess the quality of care&#44; and become an educational tool to implement improvements in the health care protocols of such patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">All authors contributed to the drafting of the manuscript and are part of the project&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Scientific Letter
Assessment of early traumatic mortality using post-mortem computed tomography
Valoración de la mortalidad traumática precoz mediante tomografía computarizada post mortem
Lidia Orejón Garcíaa,
Corresponding author
lidia.orejon@salud.madrid.org

Corresponding author.
, Laín Ibáñez Sanzb, Marcos Valiente Fernándeza, Francisco de Paula Delgado Moyaa, Elena Martinez Chamorrob, Mario Chico Fernándeza
a Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
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&#62; 50&#37;&#46; Rates &#60; 2&#37; are considered acceptable for a trauma center&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A significant limitation for the study of PM is the absence of injury identification in patients who die early&#46; Such patients are not well represented in large trauma registries&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Autopsy is considered the gold standard to assess the cause of death&#46; However&#44; its performance has decreased in recent years&#44; as it requires time and resources&#44; and clinical data for analysis are difficult to obtain&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The use of post-mortem computed tomography &#40;PMCT&#41; is a widely used tool in the field of forensic medicine and is growing thanks to its low invasiveness&#44; speed&#44; and low cost&#46; Its use in severe cases of trauma can help health care workers identify the cause of death&#44; often hidden when based solely on physical examination and basic radiology&#46; Additionally&#44; it allows for completing trauma records and verifying the correct placement of medical devices used during patient care&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5&#44;6</span></a> However&#44; no similar studies have ever been conducted in our country to this date&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This is our pilot experience performing PMCT on trauma patients who died during initial care&#46; The radiological study was conducted after death was declared to avoid post-mortem artifacts&#46; A baseline study of the whole body&#44; including limbs&#44; was performed without the administration of IV contrast and without removing the medical devices used during patient care&#46; Infusion pumps and drainage suction devices were disconnected&#44; though mechanical ventilation was maintained to prevent lung collapse&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The PMCT readings were interpreted by 2 independent radiologists experienced in the management of polytrauma patients&#46; The most plausible cause of death and the calculated ISS were determined in a joint clinical session between the Radiodiagnosis and Intensive Medicine services after reviewing the images and medical history&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The project was evaluated by the hospital research ethics committee with a favorable result&#44; required family consent for the analysis of the images and data obtained&#46; Since PMCT is a non-invasive imaging modality without any repercussions on the cadaver and its results can be affected by the time until it is eventually performed&#44; implicit consent was used for immediate performance after death&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We have managed 7 cases since 2022&#46; 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they were removed in two patients prior to performing the PMCT&#46; Still&#44; we could identify the incorrect positioning of some devices in 80&#37; of the remaining cases&#44; being the most common incorrect position the inadequate placement of the endotracheal tube in relation to the carina&#46; The most severe case was the incorrect placement of 2 chest tubes in the same patient&#44; as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">There was 1 case of PM based on ISS and TRISS&#46; The results related to the cause of death&#44; associated injuries&#44; devices&#44; and PM are shown in Table 1 of the Supplementary data&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main limitation of PMCT is the identification of solid organ injuries and vascular lesions due to the absence of IV contrast and spontaneous circulation&#46; This may cause severe injuries to go unnoticed&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8</span></a> However&#44; such injuries were inferred through indirect data such as the presence of significant hemoperitoneum&#44; organ deformity&#44; or perivascular hematoma&#46; In addition&#44; indirect findings of exsanguination&#44; such as hemothorax&#47;hemoperitoneum&#44; or large injuries to vital organs incompatible with life&#44; are enough to identify the cause of death without having to pinpoint the exact bleeding site&#46; Post-mortem angiography with IV contrast would improve these results but adds complexity to the study and use of resources&#46; Additionally&#44; its clinical utility compared to PMCT without IV contrast is currently uncertain to date&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Based on this experience&#44; we believe that the use of PMCT can be an epidemiological tool to analyze the cause of death in patients who die early from trauma&#44; study PM&#44; assess the quality of care&#44; and become an educational tool to implement improvements in the health care protocols of such patients&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors&#8217; contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">All authors contributed to the drafting of the manuscript and are part of the project&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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ISSN: 21735727
Original language: English
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