Comparitive Analysis of Computed Tomography Scan and Post Mortem Findings in Cases of Head Injury at a Tertiary Health Centre

Abstract

Background- Head injury is the leading cause of morbidity and mortality among young adults in developing economies like India and the incidences in elderly population is increasing. Computed tomography serves as the primary modality of choice in detecting fatal legions in the head. In spite of this, the fallacies of CT scan in finding these legions can’t be ignored. The present study tries to evaluate the pattern of head injury and fallacies of CT scan. Material & Method: Total 300 cases of head injury were selected for the study based on the inclusion criteria during period of December 2014 to November 2016. Results: CT scan could not detect 22.22% cases of occipital bone fracture, 21.95 % cases of temporal bone, 10.76% cases of frontal bone & 7.36% cases of parietal bone fracture. In case of fractures of base of skull, CT could not detect 71.42 % fractures of anterior & middle cranial fossa and 42.85% of the posterior fossa. Autopsy detected 20%, 71%, 10% & 100% more depressed fractures of frontal, temporal, parietal & occipital than that of CT scan respectively. CT missed linear fracture of frontal bone, parietal bone, temporal bone & occipital bone in 0%, 17%, 3%, 22% cases respectively. Considering the intracranial haemorrhages, the disparity between CT scan and autopsy in detecting extradural haemorrhage, subarachnoid haemorrhage, subdural hematoma, intracerebral haemorrhage and intraventricular hemorrhage was 7.01%, 15.21%, 15.65%, 5.40% and 11.76% respectively. With respect to traumatic brain injuries the CT could not detect cerebral oedema, brain contusions and brain lacerations in 2.45%, 2.12% and 70% cases. Conclusions: To improve the sensitivity of CT scan the use of multi detector CT with sagittal & coronal reformation should be implemented in a routine interpretation of a CT head so that forensically important fractures will not get missed.