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The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body.
Forensic Sci Med Pathol. 2020 09; 16(3):477-480.FS

Abstract

During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.

Authors+Show Affiliations

National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. khoolaysee@yahoo.com.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia. Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.National Institute of Forensic Medicine (IPFN), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32500339

Citation

Hasmi, Ahmad Hafizam, et al. "The Craniotomy Box: an Innovative Method of Containing Hazardous Aerosols Generated During Skull Saw Use in Autopsy On a COVID-19 Body." Forensic Science, Medicine, and Pathology, vol. 16, no. 3, 2020, pp. 477-480.
Hasmi AH, Khoo LS, Koo ZP, et al. The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body. Forensic Sci Med Pathol. 2020;16(3):477-480.
Hasmi, A. H., Khoo, L. S., Koo, Z. P., Suriani, M. U. A., Hamdan, A. N., Yaro, S. W. M., Arshad, S., Siew, S. F., Ibrahim, M. A., & Mahmood, M. S. (2020). The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body. Forensic Science, Medicine, and Pathology, 16(3), 477-480. https://doi.org/10.1007/s12024-020-00270-z
Hasmi AH, et al. The Craniotomy Box: an Innovative Method of Containing Hazardous Aerosols Generated During Skull Saw Use in Autopsy On a COVID-19 Body. Forensic Sci Med Pathol. 2020;16(3):477-480. PubMed PMID: 32500339.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body. AU - Hasmi,Ahmad Hafizam, AU - Khoo,Lay See, AU - Koo,Zhao Peng, AU - Suriani,Muhammad Uzair Ahmad, AU - Hamdan,Ain Nurfarahana, AU - Yaro,Siti Wira Md, AU - Arshad,Salmah, AU - Siew,Sheue Feng, AU - Ibrahim,Mohamad Azaini, AU - Mahmood,Mohd Shah, Y1 - 2020/06/04/ PY - 2020/05/25/accepted PY - 2020/6/6/pubmed PY - 2020/9/10/medline PY - 2020/6/6/entrez KW - Aerosol-generating procedure KW - Autopsy KW - COVID-19 KW - Craniotomy box KW - Safe alternative SP - 477 EP - 480 JF - Forensic science, medicine, and pathology JO - Forensic Sci Med Pathol VL - 16 IS - 3 N2 - During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics. SN - 1556-2891 UR - https://www.unboundmedicine.com/medline/citation/32500339/The_craniotomy_box:_an_innovative_method_of_containing_hazardous_aerosols_generated_during_skull_saw_use_in_autopsy_on_a_COVID_19_body_ L2 - https://dx.doi.org/10.1007/s12024-020-00270-z DB - PRIME DP - Unbound Medicine ER -