RESUMO
BACKGROUND: Head injury is the frequent cause of morbidity and mortality and frequently encountered in emergency department. Radiological examination of the skull is an indispensable part in the management of patients suffering from head trauma. AIM: To determine the accuracy of X-ray in detecting skull fractures, comparing the same with autopsy and CT evaluation. MATERIALS AND METHODS: The medico-legal cases that died of traumatic head injury and brought for autopsy over a period of two years were included in the study. Only those cases were selected who had underwent both X-ray and CT evaluation prior to death. RESULTS: When compared with autopsy, X-ray missed 19.1% of fractures while 11.9% fractures missed in contrast to CT scan. CONCLUSION: Skull X-ray is of little benefit when a CT scan is obtained. It has no added advantage over CT scan. Whenever there is facility of CT scan is available, the patient of head injury should not underwent X-ray as it can only delay the diagnosis of an associated intracranial injury and exposes the already traumatised patient to harmful radiations.
RESUMO
BACKGROUND: Emergency departments rely on CT scans to manage trauma victims, especially for head injuries. Although the detection of an undisplaced fracture on a CT scan of the head without significant intracranial findings may be insignificant for a clinician, such cases are of paramount importance for medico-legal purposes because they help ascertain the nature, manner, and cause of the head injury. AIMS: The study was conducted with the objective of knowing the sensitivity and specificity of ante-mortem CT scan findings indicating the presence or absence of skull fractures. METHODS: Findings were confirmed during post-mortem examination of the subjects who had died during management but who had not had any surgical intervention. A comparative study of ante-mortem CT scan and autopsy findings with respect to fracture in traumatic head injuries was undertaken on 60 deceased individuals brought in for medico-legal post-mortem examination over a period of two years. RESULTS: Considering the autopsy findings as the gold standard, we have concluded that 14.6 per cent of the fractures were missed on CT scan findings compared to fractures found during autopsy. The sensitivity of CT scan for skull fractures was found to be 85.4 per cent and specificity was 100 per cent. Kappa was 0.787, which shows good agreement with p<0.001, which was highly significant. CONCLUSION: In developing countries, images are interpreted in the axial plane only on a CT scan of the head, which may be due to a lack of financial and human resources. For better delineation of fractures, the use of techniques like multi-detector CT with sagittal and coronal reformations should be considered in the routine interpretation of a CT scan of the head.
