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


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


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.


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