Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims.

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.

Homicidal hanging.

Homicide by hanging is an extremely rare incident [1]. Very few cases have been reported in which a person is rendered senseless and then hanged to simulate suicidal death; though there are a lot of cases in wherein a homicide victim has been hung later. We report a case of homicidal hanging of a young Sikh individual found hanging in a well. It became evident from the results of forensic autopsy that the victim had first been given alcohol mixed with pesticides and then hanged by his turban from a well. The rare combination of lynching (homicidal hanging) and use of organo-phosporous pesticide poisoning as a means of homicide are discussed in this paper.