Comparative Analysis of the Findings of Postmortem Computed Tomography Scan and Traditional Autopsy in Traumatic Deaths: Is Technology Mutually Complementing or Exclusive?

Document Type: Original Article

Authors

1 Departments of Surgical Disciplines, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India

2 Departments of Forensic Medicine and Toxicology, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India

3 Department of Radiodiagnosis, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India

4 Departments of Surgical Disciplines, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India Abstract

Abstract

Background: Postmortem examination is indispensable to ascertain the cause of an unnatural death and as such is mandatory by the law.
From ages, traditional autopsy (TA) has proved its worth in establishing the cause of death in the deceased despite some inherent difficulties
and challenges and has enjoyed an insurmountable status. The increasing use of application of the modern-day radiology for postmortem
examination has however opened a new arena overcoming some of the difficulties of the TA. There are conflicting reports in the published
literature regarding superiority of one modality of the postmortem over the other. Objective: The objective of this study was to compare the
findings of postmortem computed tomography (CT) scan and TA in the victims of traumatic deaths and to analyze whether postmortem CT
can be used to replace TA. Materials and Methods: All patients with a history of trauma that were declared brought dead on arrival in the
emergency department were subjected to full-body CT scan. An experienced radiologist reported the findings of CT scan. Subsequently, a
forensic expert subjected the patients to TA. The physician who performed autopsy was blinded to the findings of CT scan and vice versa. An
individual who was not part of the radiology or forensic team then entered the findings of CT scan and autopsy in a predesigned Pro forma.
An unbiased assessor finally compared the findings of the two modalities and analyzed the results. McNemar’s test was used to ascertain the
level of significance between the findings reported by these two modalities considering P = 0.05 as statistically significant. The agreement or
disagreement on cause of death reported by these two modalities was also assessed. Results: About 95% of the deceased were males. The mean
age of the corpses was 35 years (range 16–67 years). CT was found superior in picking up most of the bony injuries, air-containing lesions,
hemothorax, and hemoperitoneum. However, autopsy was found more sensitive for soft-tissue and solid visceral injuries. Both modalities were
equally helpful in identifying extremity fractures. Statistically significant agreement (>95%) on cause of death by both modalities was not
achieved in any patient of trauma. Conclusion: Postmortem CT scan is promising in reporting injuries in traumatic deaths and can significantly
complement the conventional autopsy. However, at present, it cannot be considered as a replacement for TA.

Keywords


1. Jalalzadeh H, Giannakopoulos GF, Berger FH, Fronczek J, van de Goot FR, Reijnders UJ, et al. Post-mortem imaging compared with autopsy in trauma victims – A systematic review. Forensic Sci Int 2015;257:29-48.

2. Bhullar DS, Gorea RK, Aggarwal AD. Medico-legal autopsy by panel of doctors present scenario. JIAFM 2004;26:114-8.

3. Wüllenweber R, Schneider V, Grumme T. A computer-tomographical examination of cranial bullet wounds (author’s transl). Z Rechtsmed 1977;80:227-46.

4. Krantz P, Holtås S. Postmortem computed tomography in a diving fatality. J Comput Assist Tomogr 1983;7:132-4.

5. Norzailin AB, Noor Azman S, Mohd Helmee MN, Khairul Anuar Z. The sensitivity, specificity and predictive values of post mortem computed tomography in detecting liver and splenic injury due to road traffic accident. Med J Malaysia 2016;71:1-7.

6. Kaplan DA. Imaging the Deceased: Post Mortem Radiology. Available from: http://www.diagnosticimaging.com/ct/imaging-deceased-postmortem-radiology. [Last updated on 2016 Mar 03].

7. Panda A, Kumar A, Gamanagatti S, Mishra B. Virtopsy computed tomography in trauma: Normal postmortem changes and pathologic spectrum of findings. Curr Probl Diagn Radiol 2015;44:391-406.

8. Makhlouf F, Scolan V, Ferretti G, Stahl C, Paysant F. Gunshot fatalities: Correlation between post-mortem multi-slice computed tomography and autopsy findings: A 30-months retrospective study. Leg Med (Tokyo) 2013;15:145-8.

9. Leth PM, Struckmann H, Lauritsen J. Interobserver agreement of the injury diagnoses obtained by postmortem computed tomography of traffic fatality victims and a comparison with autopsy results. Forensic Sci Int 2013;225:15-9. 10. Moskała A, Woźniak K, Kluza P, Romaszko K, Lopatin O. The importance of post-mortem computed tomography (PMCT) in confrontation with conventional forensic autopsy of victims of motorcycle accidents. Leg Med (Tokyo) 2016;18:25-30.

11. Daly B, Abboud S, Ali Z, Sliker C, Fowler D. Comparison of wholebody post mortem 3D CT and autopsy evaluation in accidental blunt force traumatic death using the abbreviated injury scale classification. Forensic Sci Int 2013;225:20-6.

12. Jacobsen C, Lynnerup N. Craniocerebral trauma – Congruence between post-mortem computed tomography diagnoses and autopsy results: A 2-year retrospective study. Forensic Sci Int 2010;194:9-14.

13. Leth PM, Ibsen M. Abbreviated injury scale scoring in traffic fatalities: Comparison of computerized tomography and autopsy. J Trauma 2010;68:1413-6.

14. Levy AD, Harcke HT, Getz JM, Mallak CT. Multidetector computed tomography findings in deaths with severe burns. Am J Forensic Med Pathol 2009;30:137-41.

15. Saunders SL, Morgan B, Raj V, Rutty GN. Post-mortem computed tomography angiography: Past, present and future. Forensic Sci Med Pathol 2011;7:271-7.

16. Palmiere C, Binaghi S, Doenz F, Bize P, Chevallier C, Mangin P, et al. Detection of hemorrhage source: The diagnostic value of post-mortem CT-angiography. Forensic Sci Int 2012;222:33-9.

17. Zerlauth JB, Doenz F, Dominguez A, Palmiere C, Uské A, Meuli R, et al. Surgical interventions with fatal outcome: Utility of multi-phase postmortem CT angiography. Forensic Sci Int 2013;225:32-41.

18. Malli N, Ehammer T, Yen K, Scheurer E. Detection and characterization of traumatic scalp injuries for forensic evaluation using computed tomography. Int J Legal Med 2013;127:195-200.

19. Ross S, Ebner L, Flach P, Brodhage R, Bolliger SA, Christe A, et al. Postmortem whole-body MRI in traumatic causes of death. AJR Am J Roentgenol 2012;199:1186-92.

20. Filograna L, Tartaglione T, Filograna E, Cittadini F, Oliva A, Pascali VL, et al. Computed tomography (CT) virtual autopsy and classical autopsy discrepancies: Radiologist’s error or a demonstration of post-mortem multi-detector computed tomography (MDCT) limitation? Forensic Sci Int 2010;195:e13-7.