Abstract

Whether antemortem CT accurately reflects what autopsy later documents is a question this unit has examined before. In a prior analysis of 50 fatal TBI admissions from this tertiary care centre, CT failed to detect injuries across all 16 parameters measured, with autopsy being the reference throughout. That finding was clear enough. What remained unclear was which clinical circumstances make those failures most likely, and how large the sensitivity gap becomes under adverse conditions. This paper addresses those questions directly. The same 50 cases were re-examined with four variables in focus: GCS severity at admission, time elapsed between injury and hospital arrival, duration of survival after admission, and injury type. Non-parametric statistical tests were applied throughout, with autopsy serving as the diagnostic gold standard. Findings were consistent across all three time-related and severity-related variables. Cases with GCS ≤8 showed significantly more CT missed findings compared to moderate-injury cases. Sensitivity was higher in patients arriving within six hours than in those arriving later, and among patients who survived longer after admission, CT–autopsy agreement was notably worse. Intracranial haemorrhage and brain laceration were the injury types most often absent from CT reports, despite being present at post-mortem findings with direct medico-legal consequences.

• 1.   Dewan M.C., Rattani A., Gupta S., Baticulon R.E., Hung Y.C., Punchak M., et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2019; 130(4): 1080–97.
• 2.   Capizzi A., Woo J., Verduzco-Gutierrez M. Traumatic brain injury: An overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020; 104(2): 213–38.
• 3.   Bertozzi G., Maglietta F., Sessa F., Scoto E., Cipolloni L., Di Mizio G., et al. Traumatic brain injury: a forensic approach—a literature review. Curr Neuropharmacol. 2020; 18(6): 538–50.
• 4.   Magnusson B.M., Isaksson E., Koskinen LOD. A prospective observational cohort study of traumatic brain injury in the northern region of Sweden. Brain Inj. 2022; 36(2): 191–8.
• 5.   Yuh E.L., Jain S., Sun X., Pisica D., Harris M.H., Taylor S.R., et al. Pathological computed tomography features associated with adverse outcomes after mild traumatic brain injury. JAMA Neurol. 2021; 78(9): 1137–49.
• 6.   Dabas M.M., Alameri A.D., Mohamed N.M., Mahmood R., Kim D.H., Samreen M., et al. Comparative efficacy of MRI and CT in traumatic brain injury: a systematic review. Cureus. 2024; 16(10): e72086.
• 7.   Zhao S.Q., Shi Y.W., Wang XG, Liu K., Zhao H. Advances and challenges in traumatic brain injury from a forensic perspective. Front Neurol. 2025; 16.
• 8.   Gascho D., Thali M.J., Niemann T. Post-mortem computed tomography: technical principles and recommended parameter settings for high-resolution imaging. Med Sci Law. 2018; 58(1): 70–82.307 IJFMP/Volume 19 Number 3 July-September 2026
• 9.   Grabherr S., Egger C., Vilarino R., Campana L, Jotterand M., Dedouit F. Modern post-mortem imaging: An update on recent developments. Forensic Sci Res. 2017; 2(2): 52–64.
• 10.   Chandy P.E., Murray N., Khasanova E., Nasir M.U., Nicolaou S., Macri F. Postmortem CT in trauma: An overview. Can Assoc Radiol J. 2020; 71(3): 403–14.
• 11.   Sacco M.A., Verrina M.C., Raffaele R., Gualtieri S., Tarallo A.P., Gratteri S., Aquila I. The role of autopsy in the forensic and clinical evaluation of head trauma and traumatic brain injury in road traffic accidents: a review of the literature. Diagnostics (Basel). 2025; 15(3): 300.
• 12.   Pejavar S.R., Umesh S.R., Babladi P.I., Monteiro FNP. A postmortem study of pattern and distribution of intracranial haemorrhages in fatal head injuries following road traffic accidents. Indian J Forensic Med Toxicol. 2023; 17(2): 153–9.
• 13.   Grabherr S., Heinemann A., Vogel H., Rutty G., Morgan B., Wozniak K., et al. Postmortem CT angiography compared with autopsy: a forensic multicenter study. Radiology. 2018; 288(1): 270–6.
• 14.   Di Paolo M., Maiese A., dell’Aquila M., Filomena C., Turco S., Giaconi C., et al. Role of post mortem CT (PMCT) in high energy traumatic deaths. Clin Ter. 2020; 171(6): e490– 500.
• 15.   Tappero C., Thali M.J., Schweitzer W. The possibility of identifying brain hemorrhage in putrefied bodies with PMCT. Forensic Sci Med Pathol. 2020; 16(4): 571–6.
• 16.   Mentink M.G., Latten B.G.H., Bakers F.C.H., Mihl C., Rennenberg R.J.M., Kubat B., Hofman P.A.M. Clinical relevance of unexpected findings of post-mortem computed tomography in hospitalized patients: an observational study. Int J Environ Res Public Health. 2020; 17(20): 7572.
• 17.   Chatzaraki V., Bolliger S.A., Thali M.J., Eggert S, Ruder T.D. Unexpected brain findings in pre-autopsy postmortem CT. Forensic Sci Med Pathol. 2017; 13(3): 287–93.
• 18.   Garland J., Ondruschka B., Stables S., Morrow P., Kesha K., Glenn C., et al. Identifying fatal head injuries on postmortem computed tomography using convolutional neural network/deep learning: A feasibility study. J Forensic Sci. 2020; 65(6): 2019–22.
• 19.   Eriksson A., Gustafsson T., Höistad M., Hultcrantz M., Jacobson S., Mejare I., et al. Diagnostic accuracy of postmortem imaging vs autopsy: a systematic review. Eur J Radiol. 2017; 88: 321–8.
• 20.   Ampanozi G., Halbheer D., Ebert L.C., Thali M.J., Held U. Postmortem imaging findings and cause of death determination compared with autopsy: A systematic review of diagnostic test accuracy and meta-analysis. Int J Legal Med. 2020; 134(1): 321–37.
• 21.   Uthandi D., Sabarudin A., Mohd Z., Abdul Rahman M.A., Abdul Karim M.K. Effectiveness of post-mortem computed tomography (PMCT) in comparison with conventional autopsy: A systematic review. Curr Med Imaging. 2020; 16: 669–76.
• 22.   Henningsen M.J., Larsen S.T., Jacobsen C., Villa C. Sensitivity and specificity of postmortem computed tomography in skull fracture detection: A systematic review and meta-analysis. Int J Legal Med. 2022; 136(5): 1363–77.
• 23.   Serinelli S., Richardson T.E., Destian S., Mirchia K., Williams M., Medina-Perez M., et al. Head and brain postmortem computed tomographyautopsy correlation in hospital deaths. Am J Forensic Med Pathol. 2020; 41(3): 163–75.
• 24.   Legrand L., Delabarde T., Ludes B., Savall F., Telmon N., Dedouit F. Comparison between postmortem computed tomography and autopsy in the detection of traumatic head injuries. J Neuroradiol. 2020; 47(1): 5–12.
• 25.   Kuruc R., Szoradova A., Janik M., Krajci P., Straka L. A comparative study of intravital CT and autopsy findings in fatal traumatic injuries. Forensic Sci Int. 2022; 336: 111314.

Data Sharing Statement

Funding