DOI: 10.3886/icpsr34201
title: Utility of Whole-Body CT Imaging in the Post Mortem Detection of Elder Abuse and Neglect in Maryland, 2007
title: Archival Version

description: These data are part of NACJD's Fast Track Release and are distributed as they were received from the data depositor. The files have been zipped by NACJD for release, but not checked or processed except for the removal of direct identifiers. Users should refer to the accompanying readme file for a brief description of the files available with this collection and consult the investigator(s) if further information is needed. The general and original hypothesis to be explored in this study was that multi-slice computed tomography (CT) imaging of decedents in whom elder abuse was suspected or reported might enhance the work of the medical examiner by providing novel information not readily available at conventional autopsy and/or by ruling out the need for complete conventional autopsy in cases in which abuse findings were negative, thereby providing: time and cost efficiencies, additional evidentiary support in the form of state-of-the-art images, and, in some cases, compassionate support for families whose religions or cultures required more rapid and/or noninvasive techniques. No quantitative or qualitative data are available with this study. The data are comprised of the images taken from the autopsies of 57 decedents.
description: The study had the following primary aims: Primary aim 1: To determine whether a noninvasive protocol, consisting of an examination by a forensic pathologist for evidence of external injuries and a whole-body CT scan evaluated by a diagnostic radiologist for evidence of internal injuries, is a sensitive and accurate method for the detection or exclusion of physical abuse and/or neglect in elder individuals. Primary aim 2: To determine whether the use of the optimized version of the CT scanning protocol would obviate the need to perform complete autopsy in some percentage of cases in which elder abuse was suspected. Primary aim 3: To determine whether the use of the optimized version of the post mortem computed tomography (PMCT) scanning protocol would provide appropriate justification for full autopsy in cases in which external visual inspection was negative. Primary aim 4: To determine to what extent the optimized version of the PMCT scanning protocol would provide a time- and cost-efficient model for rapid investigation of suspected elder abuse and neglect. Primary aim 5: To the extent that aims 1-4 were successful, to prepare a database of freely available images and descriptive technical reports that would facilitate the reproduction of this scanning protocol in other medical examiners' offices.
description: The study was performed as a partnership between an academic radiology department and a state medical examiner's office. The study was prospective in nature and included the bodies of 58 decedents in which allegations of elder abuse had been made by family members, caregivers, police, or physicians. Each body underwent whole-body post mortem computed tomography (PMCT) imaging and subsequent conventional autopsy by state medical examiners within 24 hours after death. Each decedent underwent full-body CT on a multi-slice (40 detector row; Philips Medical Systems) scanner that generated detailed, high-resolution images. Because radiation risk is not a factor in post mortem imaging, the quality of images acquired was as or more detailed than that usually seen in clinical images. PMCT imaging results were interpreted with consensus readings by two radiologists with 3-24 months experience in forensic imaging. Conventional autopsy studies were performed and interpreted by state forensic medical examiners and included full medical and police reports, external body examinations, and toxicology studies. Performance and interpretation of PMCT studies were made by radiologists without knowledge of the results of conventional autopsy, and the medical examiners were likewise unaware of the results of PMCT imaging. Sensitivity of PMCT for injuries suspicious for abuse, evidence of potential neglect, and other major findings was determined with conventional autopsy considered as the standard of reference.
description: The data files are composed of images taken by using post mortem computed tomography (PMCT). Images were obtained in standard axial 2- and 3-dimensional reconstructed formats to aid in diagnosis. Approximately 3,000-4,000 individual images were generated in axial (transverse), coronal (frontal), and sagittal (lateral) projections, with different computer imaging software programs on an imaging computer workstation (TeraRecon) utilized to depict different tissues and injuries to best advantage. The following guidelines were used to detect evidence suggestive of elder abuse or neglect. Injuries considered suspicious for abuse included: Unsuspected or unreported injuries; Fractures: (1) of differing ages; (2) especially of long bones and ribs; and (3) of atypical types (e.g., spiral fracture of the humerus suggesting inflicted injury rather than a fall); Injuries in locations unlikely to be self inflicted or the result of a fall; Intracranial trauma--subdural and other intracranial hematomas; Evidence for thoracic injury associated with rib fractures (e.g., pneumothorax); Evidence for abdominal organ injuries or intra-abdominal hemorrhage; Evidence of potential neglect included decubitus sacral or ischial tuberosity ulcers, especially if deep, which may have been signs suggestive of neglect and of importance for the medical examiner's investigation.
description: Presence of Common Scales: None
description: Response Rates: Not applicable.
description: Datasets: 
 
 DS0: Study-Level Files 
 DS1: Decedent #1 
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description: These data are part of NACJD's Fast Track Release and are distributed as they were received from the data depositor. The files have been zipped by NACJD for release, but not checked or processed except for the removal of direct identifiers. Users should refer to the accompanying readme file for a brief description of the files available with this collection and consult the investigator(s) if further information is needed.
 These data are available as zip files. Each zip file contains autopsy images for one individual. The images are best viewed in a Digital Imaging and Communications in Medicine (DICOM) viewer. There are multiple DICOM viewers available for free via download. ICPSR does not endorse the use of any specific viewer, but provides the following as possibilities: (1) MicroDicom and (2) Mango. 
Users should be aware that while the study included the images of 58 decedents, the images of only 57 decedents were made available for archiving. No explanation was provided as to why 1 decedent was not included.
description: Elderly decedents in Maryland in whom abuse as a direct factor, contributing factor, or suspected long-term antecedent was suggested or suspected.
description: The study included elderly decedents age 65 and older in whom abuse as a direct factor, contributing factor, or suspected long-term antecedent was suggested or suspected. A total cohort of 80 individuals was to be imaged over the time period of the study. This total was selected based on volume of cases of suspected elder abuse or neglect referred each year to the State of Maryland Office of the Chief Medical Examiner (OCME) office (approximately 70 cases per year). The OCME is centralized in Maryland, with a single chief medical examiner having jurisdiction over all deaths in the state. Decedents came under the OCME's jurisdiction after (a) visual inspection by the medical examiner's staff at a nursing home, long-term care center, or at the decedents home suggested evidence of abuse, neglect, or suspicious contributory circumstances leading to death; (b) relatives or other advocates for the deceased voiced concerns about possible abuse or neglect; or (c) law enforcement officials requested forensic investigation and/or the recovery of physical evidence. The rate of case accrual was slower than initial projections made by the OCME. Consequently, the age range criteria for the study was expanded after 9 months from decedents over the age of 65 to include deceased younger residents of long-term care facilities (aged 18-65 years) who were suspected victims of abuse.