Claimed medical malpractice in fatal SARS-CoV-2 infections: the importance of combining ante- and post-mortem radiological data and autopsy findings for correct forensic analysis

Filograna, Laura; Manenti, Guglielmo; Arena, Vincenzo; Dell’Aquila, Marco; Pascali, Vincenzo Lorenzo; Natale, Luigi; Colosimo, Cesare; Grassi, Simone; Floris, Roberto; Oliva, Antonio

doi:10.1016/j.fri.2021.200454

Cited by 13 publications

(37 citation statements)

References 23 publications

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“…Complete consolidation of both lungs (indicative of ARDS) has also been reported in severe and advanced pulmonary COVID-19 [14]. In addition to the clinical literature, some postmortem CT (PMCT) imaging findings have been reported, though they are not specific or highly suggestive of lung SARS-CoV-2 infection [16][17][18][19][20][21][22][23][24]. As a consequence, PMCT imaging has been proposed as a useful tool for postmortem investigations in diagnosed or suspected cases of SARS-CoV-2 infection to augment the numbers of postmortem examinations, especially in the first wave [25] or more recently as a screening method for SARS-CoV-2 infection before autopsy [16][17][18][19][20][21][22]24].…”

Section: Introductionmentioning

confidence: 99%

“…As a consequence, PMCT imaging has been proposed as a useful tool for postmortem investigations in diagnosed or suspected cases of SARS-CoV-2 infection to augment the numbers of postmortem examinations, especially in the first wave [25] or more recently as a screening method for SARS-CoV-2 infection before autopsy [16][17][18][19][20][21][22]24]. In fact, due to the importance of preautopsy assessment of biological risk and the complexity of properly examining COVID-19 multiorgan involvement through sole autopsy, PMCT has been widely adopted in forensic investigations of SARS-CoV-2 suspected or ascertained-related deaths [16][17][18][19][20][21][22][23][24], especially during the first phase of the pandemic. Nevertheless, both to validate PMCT in COVID-19 cases and ensure its diagnostic value-particularly when an autopsy is not performed-it is important to find evidence regarding concordance between data obtained through PMCT and through traditional forensic autopsy.…”

Section: Introductionmentioning

confidence: 99%

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Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

Filograna

Grassi²,

Manenti

et al. 2022

Int J Legal Med

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Introduction/purpose Postmortem computed tomography (PMCT) is a valuable tool for analyzing the death of patients with SARS-CoV-2 infection. The purpose of this study was to investigate the correlation between PMCT lung findings in autopsy cadavers positive for SARS-CoV-2 infection and the severity of COVID-19 lung disease by histopathological analysis. Materials and methodsWe reviewed chest PMCT findings, paying particular attention to the lung parenchyma, in 8 autopsy cases positive for SARS-CoV-2. Correlations between chest PMCT and histopathological findings were assessed. Clinical conditions and comorbidities were also recorded and discussed. The primary cause of death was finally considered. Results In 6/8 cases, pulmonary PMCT findings were massive consolidation (4/8) and bilateral diffuse mixed densities with a crazy-paving pattern (2/8). These cases showed severe pulmonary signs of COVID-19 at histopathological analysis. In the remaining 2/8 cases, pulmonary PMCT findings were scant antideclive ground-glass opacities in prevalent gradient densities attributed to hypostasis. In 4/8 cases with massive consolidations, important comorbidities were noted. In 6/8 cases with severe pulmonary histopathological signs of lung COVID-19, autopsy found that the cause of death was cardiorespiratory failure. In the remaining 2/8 cases, histopathological analysis revealed lung alterations due to edema and some signs of SARS-CoV-2 infection; the cause of death was not attributed to SARS-CoV-2 infection (Table 1). Discussion and conclusion Chest PMCT findings correlate with the severity of COVID-19 lung disease at histopathology examination. According to our results, there may also be a relationship between cause of death and PMCT findings in COVID-19, which must be critically analyzed considering clinical antemortem data.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

Filograna

Grassi²,

Manenti

et al. 2022

Int J Legal Med

Self Cite

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“…During the pandemic, autopsies have been and are crucial both to find the actual cause of death in patients affected by SARS-CoV-2 infection and to collect information for public health (epidemiological) and research purposes [1][2][3][4][5]. Indeed, even in countries (such as the members of the European Union) where there are strict regulatory frameworks regarding privacy protection, during the pandemic, an unprecedented quantity of health data obtained from both clinical settings and autopsies, even without the consent of the patients/families, has been allowed [6].…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 viral load and replication in postmortem examinations

et al. 2022

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We examined 29 autopsy cases (investigated between October 2020 and February 2021) whose postmortem swabs tested positive for SARS-CoV-2. Twenty-two of 29 cases died while hospitalized (H), while the remaining 7 cases were not hospitalized (NH). Since we included only cases in which the time since death was known (excluding unwitnessed NH deaths), the interval between death and postmortem swab(s) was registered, with a mean NH value of 5.50 days and a mean H value of 3.98 days. The mean age of NH was 65 years, while H were older (mean age: 73 years). Twenty-eight nasopharyngeal and 27 lungs postmortem swabs were obtained and real-time reverse transcriptase‒polymerase chain reaction assay for total and replicative SARS-CoV-2 RNA and mRNA detection was performed. Although the mean death-postmortem swabs interval was higher in NH than in H, the mean viral load of NH was higher than that of H (2.53 × 10 11 copies/mL vs 9.31 × 10 8 copies/mL). In 13/29 cases (6 NH and 7 H), indicators of active replication were found. The relationship between the presence of replicative mRNA and death without hospitalization and that between the minimum cycle threshold value of SARS-CoV-2 RNA and the cycle threshold value of replicative SARS-CoV-2 mRNA were found to be statistically significant (with respective P values of 0.013 and 0.000). Therefore, especially in NH, full compliance with guidelines on biological safety in the autopsy room is essential, and no autopsy can be performed on infected cases in a structure that does not meet the established safety criteria.

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“…Indeed, medical malpractice cases are not uncommon. Early on in the pandemic, we witnessed an increase in the risk of infection, as well as the overall number of positive cases; one of the reasons for this was that many COVID-19-positive patients were relocated to nursing homes and assisted living facilities due to a shortage of hospital beds [18][19][20]. Furthermore, data regarding the disease, its treatment, and preventive measures were limited.…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, despite the high risk of infection for personnel, autopsies play a critical role, because they determine the severity of direct viral damage and assess whether organ failure plays a part in a patient's death. Multiple data sources, such as ante-and post-mortem microbiological testing, CT scans, complete forensic autopsy, and histological analyses, may be relevant in this regard [20].…”

Section: Discussionmentioning

confidence: 99%

Dying “from” or “with” COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

De-Giorgio

Grassi

Bergamin

et al. 2021

IJERPH

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There is still a lack of knowledge concerning the pathophysiology of death among COVID-19-deceased patients, and the question of whether a patient has died with or due to COVID-19 is still very much debated. In Italy, all deaths of patients who tested positive for SARS-CoV-2 are defined as COVID-19-related, without considering pre-existing diseases that may either contribute to or even cause death. Our study included nine subjects from two different nursing homes (Cases 1–4, Group A; Cases 5–9, Group B). The latter included patients who presumably died from CO poisoning due to a heating system malfunction. All subjects tested positive for COVID-19 both ante- and post-mortem and were examined using post-mortem computed tomography prior to autopsy. COVID-19 was determined to be a contributing cause in the deaths of four out of nine subjects (death due to COVID-19; i.e., pneumonia and sudden cardiac death). In the other five cases, for which CO poisoning was identified as the cause of death, the infection presumably had no role in exitus (death with COVID-19). In our attempt to classify our patients as dying with or due to COVID-19, we found the use of complete assessments (both histological analyses and computed tomography examination) fundamental.

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Claimed medical malpractice in fatal SARS-CoV-2 infections: the importance of combining ante- and post-mortem radiological data and autopsy findings for correct forensic analysis

Cited by 13 publications

References 23 publications

Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results

SARS-CoV-2 viral load and replication in postmortem examinations

Dying “from” or “with” COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

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