Does Postmortem Imaging Provide Additional Findings After Unexpected Deaths in Infants and Children

The yield of postmortem imaging (PMI) after sudden unexpected deaths in children has not been well studied. Findings consistent with physical abuse detected on PMI may alert the physician to this diagnosis before the autopsy results. Our objectives are to describe the PMI performed and their diagnostic yield after unexpected deaths in children and to adherence to the American Academy of Pediatrics guidelines regarding performance of skeletal survey and autopsy in infants at our institution. METHODS We performed a retrospective study of unexpected deaths in children 2 years or younger between 2008 and 2018. Children with known traumatic deaths and those transferred after a cardiopulmonary arrest at an outside institution were excluded. We collected patient demographics, physical examination findings, and type of PMI performed along with their results. RESULTS We analyzed 150 deaths with majority (128; 85.3%) being infants. No PMI was performed in 20 children (13.3%). An autopsy was not performed in 22 children (14.6%). A skeletal survey and an autopsy were performed only in 72.6% (93/128) infants. PMI provided additional findings in 51 infants (34%) and 13 children (59.1%) aged 13 to 24 months. PMI identified abuse in 11 children with a negative physical examination result, 3 of whom had a negative autopsy. CONCLUSIONS The American Academy of Pediatrics recommendations of performance of a skeletal survey and an autopsy were not adhered to after all infant deaths. PMI is useful in identification of additional findings in children 2 years or younger, especially those concerning for physical abuse in infants with a negative physical examination.