Perimortem Skeletal Sharp Force Trauma: Detection Reliability on CT Data, Demographics and Anatomical Patterns from a...

Area of Science:

• Forensic Pathology
• Radiology
• Traumatology

Background:

• Postmortem computed tomography (PMCT) is increasingly vital for trauma analysis.
• Forensic curricula and best practice manuals inadequately address PMCT for sharp force trauma.
• Sharp force injuries often present subtle bone lesions detectable by PMCT.

Purpose of the Study:

• To assess the accuracy of PMCT in detecting sharp force bone lesions in closed forensic cases.
• To identify patterns in the anatomical location and manner of death (MOD) associated with bone lesions.
• To evaluate the repeatability of lesion detection and compare PMCT findings with forensic reports.

Main Methods:

• Analysis of 41 closed sharp force fatality cases with available PMCT and forensic reports.
• Two observers with varying radiological training assessed bone lesions on 2D and 3D PMCT scans.
• Comparison of PMCT findings with established forensic reports to determine detection rates and errors.

Main Results:

• Visible bone lesions were detected in 3% (suicides) to 15.3% (homicides) of sharp force injuries.
• Detection of bone lesions on PMCT was repeatable but missed a significant number compared to forensic reports.
• Thoracic bone lesions were most frequent overall, with injury patterns differing by MOD.
• Significant associations were found between MOD, age, and the number of injuries.

Conclusions:

• Detecting bone lesions via PMCT is challenging for untrained forensic specialists, necessitating improved curricula and manuals.
• The low frequency of bone lesions compared to soft tissue injuries requires careful consideration, especially in decomposed bodies.
• PMCT analysis of sharp force trauma requires specialized training and standardized guidelines for optimal accuracy.