Abstract
BackgroundThe aim of our study was to analyze the reliability of postmortem computed tomography (PMCT) versus autopsy in detecting signs of blood aspiration in a distinct group of patients following deadly head, mouth or floor of mouth gunshot injuries.MethodsIn this study, in 41 cases PMCT was compared to autopsy reports, the gold standard of postmortem exams, regarding detection of blood aspiration. PMCT was evaluated for the presence and level of typical signs of blood aspiration in the major airways and lung using a semi-quantitative scale ranging from level 0 (no aspiration) to 3 (significant aspiration) also taking density values of the described potential aspiratory changes into account.ResultsOverall, in 29 (70.7%) of 41 enrolled cases PMCT and autopsy revealed the same level of aspiration. A difference of one level between PMCT and autopsy resulted for 5 (12.2%) of the remaining 12 cases. More than one level difference between both methods resulted for 7 cases (17.2%). Autopsy described no signs of aspiration in 10 cases, compared to 31 cases with reported blood aspiration. In contrast, PMCT revealed no signs of blood aspiration in 15 cases whereas 26 cases were rated as positive for signs of aspiration in the major airways. In 18 of these 26 cases considered positive for blood aspiration by autopsy and PMCT, clear signs of aspiration signs were also described bilaterally by both methods.ConclusionsThe presented study provides evidence for the assumption that PMCT seems to be helpful in the detection of blood aspiration in cases of deadly head gunshots. In conclusion, it seems reasonable to suggest performing PMCT additionally to traditional postmortem exams in cases of suspected aspiration to rule out false-negative cases and to possibly allow for a more detailed and rather evidence based examination reconnoitering the cause of death. However, the adequate use of PMCT in this context needs further evaluation and the definition of an objective scale for aspiration detection on PMCT needs to be established in future studies.
Highlights
The aim of our study was to analyze the reliability of postmortem computed tomography (PMCT) versus autopsy in detecting signs of blood aspiration in a distinct group of patients following deadly head, mouth or floor of mouth gunshot injuries
General data Between October 2008 and April 2011, overall 57 cases with head gunshot-related death underwent PMCT and autopsy. 16 head shot cases sustained additional gunshot to chest and/or thoracic spine so that they were excluded from the study
Major airways The status of the airways regarding the present signs of aspiration was rated as equal in autopsy and PMCT in 22 of the 41 enrolled cases
Summary
The aim of our study was to analyze the reliability of postmortem computed tomography (PMCT) versus autopsy in detecting signs of blood aspiration in a distinct group of patients following deadly head, mouth or floor of mouth gunshot injuries. One of the major issues in forensic practice is to determine whether an injury was inflicted during life or after death [1, 2]. The reliability of the four basic vital reactions needs to be carefully assessed, since several confounders, e.g., petechial bleeding caused by hypostasis, potentially may alter the final aspect [3, 4]. If breathing stops along with circulatory arrest or brain death signs of vitality based on an intact respiration can highly reliable be attributed [3, 4]. Detecting signs of aspiration is of high forensic relevance due to the fact that it provides information whether an injury occurred pre- or postmortem and/or it was the primary or contributing factor to the cause of death. Blood aspiration with blood found deep in the bronchial tree is accepted
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