Ante mortem CT aspects versus autopsy findings in head trauma

B. Hanganu, T. A. Stratulat, A. A. Hleșcu, I. S. Manoilescu, B. Gafton, B. G. Ioan,

Abstract: Head trauma is one of the leading causes of death worldwide, the main circumstances for occurrence in Europe being road traffic accidents and falls.CT examination is considered to be “the gold standard” for the diagnosis and non-invasive assessment, as well as for the management of head trauma. Autopsy represents “the gold standard” for the postmortem diagnosis and assessment of head injuries. Nevertheless, the ante-mortem CT examinations performed during hospital admissions are likewise important in the postmortem evaluation of the head injuries, and the comparison between the ante-mortem and post-mortem CT examinations may help for a better understanding of the post-mortem findings.In this paper, the authors present the results of a retrospective study which aimed to analyze the correspondence between the injuries diagnosed by CT imaging while the patients who suffered head trauma were admitted in the hospital and the injuries identified at the autopsy of these patients in order to establish which injuries are missed on CT imaging, as well as the factors influencing the discrepancies between antemortem and postmortem diagnosis.The results of our study show a significant discrepancy in most cases between the injuries identified by CT examination and the injuries identified during autopsy, both regarding the missed injuries and the over-diagnosed injuries, a total agreement being recorded only in 4 of the 114 cases. The analysis of the potentially involved factors resulted in a direct link with the number of injuries, the risk to overlook a fracture being higher as the number of injuries is higher. The most frequently missed injuries during CT examination were: ventricular hemorrhage, brain contusion and the fractures in the anterior and posterior floors of the base of the skull, while the most over-diagnosed injuries during CT examination were the extradural hematoma and fractures of the skull sutures. The authors underline the importance of studies aimed to identify the factors that contribute to the discrepancies between the results of the CT examination and the autopsy findings in the victims with head trauma, in order for the measures to decrease the discrepancies between the two examinations to be identified.
Keywords: head trauma, diagnosis, CT scan, autopsy, agreement/disagreement rate