Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
Department of Forensic Medicine, Jena University Hospital, Jena, Am Klinikum 1, 07747, Jena, Germany.
Eur J Radiol. 2020 Nov;132:109297. doi: 10.1016/j.ejrad.2020.109297. Epub 2020 Sep 28.
Our study sought to evaluate validity of forensic postmortem CT in establishing cause of death (COD) in suspected unnatural adult death based on the reference standard of autopsy.
In our prospective, single-center study, 64 of 94 consecutive corpses (70.7 % male, mean age: 47.4 years) who underwent CT and autopsy between November 2013 and April 2019 were included in the analysis. Primary objective was agreement between CT and autopsy on primary COD using kappa statistics. Secondary objectives were competing COD and specific pathological findings.
Agreement on primary COD between forensic CT and autopsy without or in consideration of toxicological and histological findings was strong (85.9 % [55 of 64 corpses]; κ = 0.83 [95 %CI: 0.74 to 0.93] and 95.3 % [61 of 64 corpses]; κ = 0.94 [95 %CI: 0.84-1.04], respectively, McNemar p = 0.03). Sensitivity and specificity of CT in identification of acute heart failure, intracranial bleeding, burns and heat shocks, gunshot wounds, polytrauma, cranio-cerebral trauma, and strangulation or hanging was 100 %, each. Acute respiratory failure was detected with a sensitivity and specificity of 100 % and 96.8 %, cuts and stab wounds with 95.2 % and 100 %, and intoxication, pneumonia, or gastrointestinal bleeding with 60.0 % and 100 %, respectively. Agreement on competing COD was moderate (51.6 %, [33 of 64 corpses]; κ = 0.47 [95 %CI: 0.40 to 0.53], p < 0.001).
Forensic postmortem CT, complemented by external, toxicological, and histological examination was sufficiently valid to assess primary COD in the majority of suspected unnatural deaths with few restrictions.
本研究旨在评估法医学死后 CT 检查在确定疑似非自然死亡成人死因（COD）方面的有效性，以尸检为参考标准。
在我们的前瞻性、单中心研究中，纳入了 2013 年 11 月至 2019 年 4 月期间连续进行 CT 和尸检的 94 具尸体中的 64 具（70.7%为男性，平均年龄：47.4 岁）。主要目的是使用 Kappa 统计评估 CT 与尸检在主要 COD 上的一致性。次要目的是确定竞争 COD 和特定的病理发现。
在不考虑毒理学和组织学发现或考虑毒理学和组织学发现的情况下，法医学 CT 与尸检在主要 COD 上的一致性较强（85.9%[55/64 具尸体]；κ=0.83[95%CI：0.74-0.93]和 95.3%[61/64 具尸体]；κ=0.94[95%CI：0.84-1.04]，McNemar p=0.03）。CT 识别急性心力衰竭、颅内出血、烧伤和热冲击、枪伤、多发伤、颅脑创伤、绞杀或缢死的灵敏度和特异性均为 100%。急性呼吸衰竭的灵敏度和特异性分别为 100%和 96.8%，切割和刺伤的灵敏度和特异性分别为 95.2%和 100%，中毒、肺炎或胃肠道出血的灵敏度和特异性分别为 60.0%和 100%。竞争 COD 的一致性为中等（51.6%[33/64 具尸体]；κ=0.47[95%CI：0.40-0.53]，p<0.001）。
法医学死后 CT 检查，辅以外部、毒理学和组织学检查，在大多数疑似非自然死亡的情况下，可充分有效地评估主要 COD，限制较少。
