Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments

Purpose. The aim of this study was to evaluate the effectiveness of a worksheet for diagnosing postmortem computed tomography (PMCT) in emergency departments (EDs). Materials and methods. A total of 49 cases of clinically diagnosed nontraumatic deaths in the ED who underwent total body PMCT were enrolled. PMCT images were prospectively evaluated by four radiologists: two radiologists with 1.5 and 3.5 years of residency and two board-certified radiologists with >20 years of experience. Readers were independently instructed to detect and interpret findings with reference to fatal findings, postmortem features, changes caused by cardiopulmonary resuscitation, and other pathological findings according to a worksheet that was composed of the possible findings previously reported. Agreement on detection and interpretation of findings between each reader was measured using Cohen's kappa coefficients. Results. For the detection of findings, there was substantial agreement among the four readers (kappa > 0.60, P < 0.0001). There was substantial (kappa > 0.60, P < 0.0001) and near-substantial (kappa = 0.60, P < 0.0001) agreement in the interpretation of the finding. Conclusion. Results of our study suggest equivalency on diagnosing PMCT regardless of the reader's level of experience. We conclude that the worksheet is useful for diagnosing PMCT in emergency departments.