Barry David Daly MD, Presenter: Data Safety Monitoring Board, Watermark Research Partners, LLC, Indianapolis, IN

Sopo Lin, Abstract Co-Author: Nothing to Disclose

Zabiullah Ali MD, Abstract Co-Author: Nothing to Disclose

Minh Lu MD, Abstract Co-Author: Nothing to Disclose

Krystal Archer-Arroyo MD, Abstract Co-Author: Nothing to Disclose

Clint W. Sliker MD, Abstract Co-Author: Nothing to Disclose

Michael E. Mulligan MD, Abstract Co-Author: Nothing to Disclose

David Fowler MD, Abstract Co-Author: Nothing to Disclose

Elder abuse (EA) contributing to death is a crime that is difficult to exclude without a full conventional autopsy (CA), even where allegations of abuse are limited to nonphysical issues. We investigated the potential for use of whole-body post mortem CT (PMCT) as a triage tool to determine the need for CA based on detection of injuries suggestive of physical abuse and/or evidence suggestive of neglect.  

52 decedents (12 M, 40 F; mean age 76 y, range 52-93 y) with associated allegations of EA had PMCT and subsequent CA by state medical examiners within 24 h of death. PMCT scans were interpreted by radiologists experienced in forensic imaging. Sensitivity of PMCT for injuries suspicious for abuse, evidence of potential neglect, and other major findings were determined with CA as the standard of reference.  

PMCT was concordant with CA for evidence/absence of elder abuse in all cases. PMCT demonstrated multiple previously unreported fractures of varying age consistent with EA in only 1/52 cases. Recent fractures consistent with cardiac resuscitation (CPR) or typical accidental trauma were noted on PMCT in 18/52 (35%) and 5/52 (10%), respectively, but at CA were undetected in 7/18 (39%) and 4/5 (80%), respectively. PMCT misinterpreted an undisplaced cervical fracture in the setting of severe degenerative disease. PMCT identified decubitus ulcers in 14/52(27%) cases, 9(64%) of which were unreported at CA. Cause of death was determined by PMCT in 24/52(46%) and by CA in 50/52(96%) cases.

PMCT is reliable for the detection or exclusion of skeletal injuries suspicious for elder abuse and may be used (in correlation with history and external examination) to determine the need for CA where allegations or suspicion of abuse are raised. Decubitus ulcers suggestive of neglect are more accurately detected at PMCT than CA. Acute upper anterior bilateral rib fractures were noted in all decedents who underwent full CPR, likely related to osteopenia/osteoporosis. PMCT was not reliable for determination of cause of death in this decedent group.

  PMCT is reliable for detection or exclusion of skeletal injuries suspicious for elder abuse and may be used as a triage tool to help determine the need for conventional autopsy.

Daly, B, Lin, S, Ali, Z, Lu, M, Archer-Arroyo, K, Sliker, C, Mulligan, M, Fowler, D, Utility of Whole-body Post Mortem Computed Tomography Imaging in Detection of Elder Abuse and Neglect: Comparison with and Potential Substitution for Standard Autopsy.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003375.html