Traumatic injuries reflecting homicidal, suicidal, and accidental circumstances, as well as poisoning (both accidental and suicidal), are common causes of death in cases typically investigated by medical examiners. The Centers for Disease Control and Prevention (CDC) estimates that more than 50,000 deaths result from some form of violent trauma each year.
The National Academy of Sciences, the researchers note, has recommended that the implementation of advanced imaging technology be further studied as a possible component of medicolegal death investigations. Working with the New Mexico Office of the Medical Investigator, the researchers evaluated whether postmortem computed tomography (PMCT) “might supplant or supplement forensic autopsy.” The team evaluated 174 blunt force injury deaths, 205 firearm deaths, 65 pediatric trauma deaths, and 460 drug poisoning deaths that occurred between June 2011 and December 2013. In each case a full autopsy and complete PMCT were performed.
The researchers found that there was strong agreement between autopsy and PMCT in assigning the cause of death. In 85 percent of blunt force injury deaths, 99.5 percent of firearm fatalities, and 81.4 percent of pediatric trauma deaths, the cause of death determined by the PMCT was correct, matching the autopsy. Agreement on cause of death was significantly less in drug poisoning deaths, ranging from 34.2 percent to 77.9 percent, with significantly less agreement in people over the age of 40.
PMCT detected more injuries than autopsy in the blunt force and firearm cases, but autopsy detected more in pediatric trauma and drug poisoning cases.
“In an ideal world,” the researchers concluded, “all medical examiners would have access to not only a CT scanner, but an experienced radiologist to interpret the results from the scans for them. Our results indicate that autopsy misses injuries that can only be seen on PMCT for 17 to 21 percent of all injuries in decedents whose deaths are due to firearm fatalities, pediatric trauma, or blunt force injuries.”
In the majority of cases included in the study, the researchers said, “PMCT, when paired with a thorough external examination, could supplant autopsy and would be of particular value in cases of family, religious, or cultural objections (to autopsy).”
About this Article
The work described in the article was supported by NIJ cooperative agreement number 2010-DN-BX-K205, awarded to the University of New Mexico Health Sciences Center.
This article is based on the grant report Utility of Postmortem X-ray Computed Tomography (CT) in Supplanting or Supplementing Medicolegal Autopsies (pdf, 98 pages) by Sarah L. Lathrop, D.V.M., Ph.D., and Kurt B. Nolte, M.D.