Could ante-mortem computed tomography be useful in forensic pathology of traumatic intracranial haemorrhage?

Background: Imaging techniques have proven valuable in forensic pathology practice, with computed tomography being preferred for forensic use. In the era of virtual autopsy and a low- to middle-income, resource-constrained country, a question arises as to whether ante-mortem computed tomography (ACT) could be cost-effective by reducing the number of invasive autopsies performed.

Objective: The objective of this study was to assess the usefulness of ACT in forensic pathology by examining discrepancy rates between ACT scans and autopsy findings in cases of deceased individuals with traumatic intracranial haemorrhages and assess factors associated with discrepancies.

Methods: Eighty-five cases of ACT and autopsy reports from 01 January 2014 to 31 December 2016 from the Polokwane Forensic Pathology Laboratory, South Africa, were analysed retrospectively. Using Cohen's kappa statistics, measures of agreement and resultant discrepancy rates were determined. Also, the discrepancy patterns for each identified factor was also analysed.

Results: The discrepancy rate between ACT and autopsy detection of haemorrhage was 24.71% while diagnostic categorisation of haemorrhage was 55.3%. Classification discrepancy was most observed in subarachnoid haemorrhages and least observed in extradural haemorrhages. A markedly reduced level of consciousness, hospital stay beyond two weeks and three or fewer years of doctors' experience contributed to classification discrepancies.

Conclusion: Ante-mortem computed tomography should be used only as an adjunct to autopsy findings. However, the low discrepancy rate seen for extradural haemorrhages implies that ACT may be useful in the forensic diagnosis of extradural haemorrhages.