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

Abstract

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