The Role of Radiology (X-Ray versus Computed Tomography) in Medicolegal Cases Presented at a Tertiary Care Hospital in Pakistan

Abstract

Objectives: A prospective observational study was aimed to assess the role of plain radiographs and computed tomography in detecting head injuries presented at the medicolegal office at the Forensics and Radiology Departments, Gambat Medical Hospital, Sindh.
 Material and Methods: All cases referred from the Medicolegal Office (MLO) with head injury were included. All victims underwent X-ray head and computed tomography skull was done with 1 or 1.5 cm thick axial sections without administration of intravenous contrast. The radiological reports of X-ray head and CT scans were documented and comparatively evaluated.
 Results: Mean age was 38.63 ± 3.91 years. In 51 (45.13%) cases, X-ray was able to detect skull fracture, while CT scan detected 64(56.64%) skull fractures. There were 54 (84.3%) true positives, 3 (2.6%) false positives, 10(8.8%) false negatives, and 40 (40.7%) true negatives. The accuracy of X-ray to detect skull fracture was 88.50%.
 Conclusion: X-ray had a sensitivity and specificity of 84.38% and 93.88%, respectively. It is a reliable tool to detect skull fractures in victims of assault in comparison with CT scans. X-ray is also associated with low dose radiation exposure as compared with CT scan which delivers 70 times more exposure than the former.

The most optimum imaging modality for diagnosis of shajjah hurt in medicolegal cases of head injuries.

“…4,5 The peculiarity of Pakistani Islamized law requires precise description of lesion that affected head area for medicolegal certification and there is no standard guideline / protocol for the evaluation of medicolegal head injuries (Shajjah hurt) in contrast to established guideline for selective neuroimaging in medical or neurosurgical cases. 6,7 Shajjah or injuries/hurt of the head and face, according to the most recent act are categorized https://doi.org/10.29309/TPMJ/2023.30.01.7122 2 as per law into six types. 8 These six categories are in an order of increasing severity and seriousness.…”