Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series.

Area of Science:

• Forensic Radiology
• Medical Examiner Systems

Background:

• Postmortem computed tomography (PMCT) is increasingly used in medicolegal death investigations.
• Its utility in firearm homicide cases requires further evaluation.

Purpose of the Study:

• To assess the value of PMCT in identifying injuries relevant to the cause of death in firearm homicide cases.
• To analyze discrepancies between PMCT findings and autopsy results.

Main Methods:

• Retrospective review of 80 firearm homicide cases from a statewide medical examiner's office.
• Forensic pathologists reviewed PMCT scans before autopsy; a forensic radiologist re-evaluated scans blinded to autopsy findings.
• Injuries were scored by body region, and discrepancies analyzed using a modified Goldman classification and McNemar's test.

Main Results:

• PMCT identified injuries relevant to the cause of death in 79.1% of cases, primarily in a single body region (head-neck or thoracoabdominal).
• Nine cases had missed major diagnoses by PMCT outside the primary injured region, including six extremity injuries visible externally.
• All cases had evident lethal firearm injuries despite potential missed diagnoses.

Conclusions:

• PMCT is valuable for identifying major firearm injuries in homicide victims.
• PMCT can help exclude injuries unrelated to the cause of death when injuries are localized to a single region.
• Combining PMCT with external examination may optimize dissection strategies in medicolegal death investigations.