Radiographs interpretation by forensic pathologists: a word of warning

Area of Science:

• Forensic Pathology
• Pediatric Radiology
• Child Abuse Investigation

Background:

• Radiologic examination is crucial for diagnosing child abuse in child death investigations.
• Forensic pathologists in Quebec interpret radiographs independently due to budget constraints.
• This practice raises concerns about diagnostic accuracy without specialist radiologist input.

Purpose of the Study:

• To assess the validity of radiologic interpretations by non-radiologist forensic pathologists.
• To compare forensic pathologist's conclusions with expert pediatric radiologist's interpretations.
• To evaluate the impact of missed radiologic findings on child death investigations.

Main Methods:

• Review of all child death cases over a one-year period in Quebec.
• Independent review of radiographs by an experienced pediatric radiologist.
• Comparison of the radiologist's interpretations with the original forensic pathologist's conclusions.

Main Results:

• Forensic pathologists missed significant findings in 3 out of 20 reviewed cases.
• None of the missed radiologic findings altered the final diagnosis or case outcome.
• Other autopsy findings were sufficient to establish the final diagnosis in the cases with missed radiologic information.

Conclusions:

• While missed findings did not change outcomes in this study, the results are concerning.
• Reliance on non-specialist interpretation may lead to a decrease in diagnostic quality.
• Cost-saving measures restricting access to expert consultants can impact forensic investigation quality.