Utility of CDC Screening Guidelines and Autopsy Findings in Identifying Decedents Who Die of SARS-CoV-2 Infection

• Published in: The American journal of forensic medicine and pathology Vol. 42; no. 2; pp. 118 - 120
• Main Authors: Konopka, Kristine E., Nguyen, Teresa, Hlavaty, Leigh, Rayes, Omar, Schmidt, Carl J., Dahl, Julia, Myers, Jeffrey L.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-06-2021
• Subjects: Adolescent; Adult; Aged; Autopsy; Bronchopneumonia - pathology; Centers for Disease Control and Prevention, U.S; Checklist; Child; Child, Preschool; COVID-19 - diagnosis; COVID-19 - mortality; COVID-19 Testing; Female; Humans; Infant; Lung - pathology; Male; Middle Aged; Nasopharynx - virology; Original; Practice Guidelines as Topic; Pulmonary Alveoli - pathology; Pulmonary Embolism - pathology; Respiratory Aspiration - pathology; Specimen Handling; United States; Young Adult; United States
• ISSN: 0195-7910; 1533-404X
• DOI: 10.1097/PAF.0000000000000681

We assess the utility of a Centers for Disease Control and Prevention (CDC) guidelines-based coronavirus disease 2019 (COVID-19) screening checklist for postmortem severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surveillance, detailing the relationship between the histologic findings at autopsy and attribution of death to COVID-19.SARS-CoV-2 nasopharyngeal swabs were collected at the time of autopsy in all "checklist-positive" decedents. Additional "checklist-negative" decedents were randomly tested daily. Lung slides were blindly reviewed by 3 pathologists, assessing for the presence of diffuse alveolar damage (DAD) and other findings. Sixteen decedents had positive postmortem SARS-CoV-2 nasopharyngeal swabs and underwent complete autopsies. Seven decedents had positive screening checklists. Of these, 4 had DAD and 1 had COVID-19-associated thromboembolic disease. Of the 9 decedents with negative screening checklists, 2 had DAD, but only 1 was attributed to COVID-19; the other was likely drug related. Acute bronchopneumonia was the second most common finding, and aspiration was the likely etiology in cases without concomitant DAD. COVID-19-related DAD was identified more commonly in decedents who screened positive by CDC checklist, but false-negatives did occur. Medical examiner offices should maintain a low threshold for random testing of decedents even when COVID-19 is not suspected.