The Role of Radiology (X-Ray versus Computed Tomography) in Medicolegal Cases Presented at a Tertiary Care Hospital in Pakistan
DOI:
https://doi.org/10.36552/pjns.v25i2.534Keywords:
Computed Tomography, Forensic Medicine, Head InjuryAbstract
Objectives: A prospective observational study was aimed to assess the role of plain radiographs and computed tomography in detecting head injuries presented at the medicolegal office at the Forensics and Radiology Departments, Gambat Medical Hospital, Sindh.
Material and Methods: All cases referred from the Medicolegal Office (MLO) with head injury were included. All victims underwent X-ray head and computed tomography skull was done with 1 or 1.5 cm thick axial sections without administration of intravenous contrast. The radiological reports of X-ray head and CT scans were documented and comparatively evaluated.
Results: Mean age was 38.63 ± 3.91 years. In 51 (45.13%) cases, X-ray was able to detect skull fracture, while CT scan detected 64(56.64%) skull fractures. There were 54 (84.3%) true positives, 3 (2.6%) false positives, 10(8.8%) false negatives, and 40 (40.7%) true negatives. The accuracy of X-ray to detect skull fracture was 88.50%.
Conclusion: X-ray had a sensitivity and specificity of 84.38% and 93.88%, respectively. It is a reliable tool to detect skull fractures in victims of assault in comparison with CT scans. X-ray is also associated with low dose radiation exposure as compared with CT scan which delivers 70 times more exposure than the former.
References
2. Sohail S, Qureshi SR. Application of qisas and diyat act's terms for reporting in current forensic radiology practice. Journal of the College of Physicians and Surgeons--pakistan: Jcpsp. 2007 Jul 1;17(7):402-5.
3. Yousfani GM, Sohail S, Memon MU. Radiological Appraisal of Moderate to Severe Head Injury±Medicolegal Implications. JLUMHS. 2010 Sep;9(03):121-24.
4. Sohail S, Qureshi SR. Application of qisas and diyat act's terms for reporting in current forensic radiology practice. Journal of the College of Physicians and Surgeons--pakistan: JCPSP. 2007 Jul 1;17(7):402-5.
5. Vakilian A, Farahmand H, Sharifi-Razav A, Tajik F, Najmaddini M. Epidemiological, Clinical and Radiological Characteristics of Patients with Head Trauma. Internal Medicine And Medical Investigation Journal. 2017 Mar 20;2(1):7-14.
6. Sameer C, Joshi HS, Gaurav J, Kashmir S. Outcome of head injury patients based on computed tomography (CT) scan findings in a Tertiary Care Hospital:-A cross-sectional study. IJCMR. 2016;3(2):610-2.
7. Kaye AH. Head injuries. Textbook of Surgery. 2019 Dec 18:481-92.
8. Mossman D, Bowen MD, Vanness DJ, Bienenfeld D, Correll T, Kay J, Klykylo WM, Lehrer DS. Quantifying the accuracy of forensic examiners in the absence of a “gold standard”. Law and Human Behavior. 2010 Oct;34(5):402-17.
9. Sharma R, Murari A. A comparative evaluation of CT scan findings and post mortem examination findings in head injuries. Indian Internet Journal of Forensic Medicine & Toxicology. 2006;4(2).
10. Ismail A, Azez E. ROLE OF COMPUTED TOMOGRAPHY (CT) IN DIAGNOSIS OF URGENT HEAD TRAUMA IN ADULT. Romanian Journal of Neurology. 2018;17(2):84. DOI: 10.37897/RJN.2018.2.6
11. Mohamed Refaat RM, Haroun MR, El Din S, Hussein AY. MEDICO LEGAL ASPECTS OF TRAUMATIC HEAD INJURIES IN BENHA UNIVERSITY HOSPITAL (PROSPECTIVE ANALYTICAL STUDY).. The Egyptian Journal of Forensic Sciences and Applied Toxicology. 2019 Dec 1;19(4):119-45.
12. Onwuchekwa RC, Echem RC. An epidemiologic study of traumatic head injuries in the emergency department of a tertiary health institution. Journal of Medicine in the Tropics. 2018 Jan 1;20(1):24. DOI: 10.4103/jomt.jomt_28_17
13. Wright JN. CNS injuries in abusive head trauma. American Journal of Roentgenology. 2017 May;208(5):991-1001.
14. Sidpra J, Ong J, Birch W, Mankad K. Skull fractures in abusive head trauma: a single centre experience and review of the literature. Child's nervous system. 2020 Sep 15:1-1. https://doi.org/10.1007/s00381-020-04870-6
15. Menon A, Kanchan T, Rao NG. Skull fractures in fatal head injuries-a comparative analysis of CT and autopsy findings. Journal of Forensic Medicine & Toxicology. 2012;29(1):55.
16. Goyal M, Goyal R, Kochar SR, Goel MR. Fracture of the temporal bone: A tomographic V/S autopsy study. Journal of Indian Academy of Forensic Medicine. 2007;29(2):76-9.
17. Chawla H, Yadav RK, Griwan MS, Malhotra R, Paliwal PK. Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims. The Australasian medical journal. 2015;8(7):235.
18. Spies AJ, Steyn M, Brits D. A comparison of computed tomography, X?ray and Lodox® scans in assessing pediatric skull fractures using piglets. Journal of Forensic Sciences. 2020 Nov 2. https://doi.org/10.1111/1556-4029.14614
19. Korduke N, Singh T. Imaging of midface fractures—a retrospective study. Imaging. 2019 Jul 12;132(1498).
20. Baglivo M, Winklhofer S, Hatch GM, Ampanozi G, Thali MJ, Ruder TD. The rise of forensic and post-mortem radiology—analysis of the literature between the year 2000 and 2011. Journal of Forensic Radiology and Imaging. 2013 Jan 1;1(1):3-9.
21. Eames T. Computed Tomography in Medicolegal Death Investigation: A Critical Review. DOI 10.15760/honors.951
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).