Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice
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Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities.
The aim of this study was to review the diagnostic yield of this practice.
Materials and 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.
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.
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.
KeywordsRadiography Post-mortem Foetal Perinatal Dysplasia
Conflicts of interest
Dr Owen Arthurs is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship, and Professor Andrew M. Taylor is funded by an NIHR Senior Research Fellowship. Professor Neil J. Sebire, Professor Lyn Chitty and Professor Andrew M Taylor are partially supported by the Great Ormond Street Children’s Charity and the Great Ormond Street Hospital Biomedical Research Centre. This article presents independent research funded by the NIHR and supported by the Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the authors and are not necessarily those of the National Health Service, the NIHR or the Department of Health.
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