Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series

Authors

Marloes E M Vester, Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
Kurt B Nolte, Office of the Medical Investigator, University of New Mexico School of Medicine, 1101 Camino de Salud, Albuquerque, NM, 87102
Gary M. Hatch, Office of the Medical Investigator, University of New Mexico School of Medicine, 1101 Camino de Salud, Albuquerque, NM, 87102
Chandra Y. Gerrard, Office of the Medical Investigator, University of New Mexico School of Medicine, 1101 Camino de Salud, Albuquerque, NM, 87102
Reinoud D. Stoel, Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands
Rick R. van Rijn, Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

Document Type

Article

Publication Date

9-1-2020

Abstract

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner's office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head-neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar's test. We included 60 males and 20 females (median age 31 years, range 3-73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head-neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.

Recommended Citation

Vester MEM, Nolte KB, Hatch GM, Gerrard CY, Stoel RD, van Rijn RR. Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series. J Forensic Sci. 2020 Sep;65(5):1568-1573. doi: 10.1111/1556-4029.14453. Epub 2020 May 13. PMID: 32402110; PMCID: PMC7496672.