Abbreviated injury scale-guided assessment of traumatic deaths: postmortem CT versus autopsy

Abstract

Objective: This study aimed to evaluate the diagnostic agreement between postmortem computed tomography (PMCT) and conventional autopsy in assessing injury severity and determining the cause of death using the Abbreviated Injury Scale (AIS). Materials and methods: A retrospective analysis was conducted on 65 trauma-related fatalities that underwent both PMCT and autopsy. Injuries were classified by anatomical region and scored using AIS. Severity was categorized as minor (AIS 0–3) or major (AIS 4–6). The cause of death was determined based on either expert opinion or the highest AIS score per region. Agreement between PMCT and autopsy was analyzed using kappa statistics, correlation coefficients, and chi-square tests. Results: Moderate agreement in AIS scoring was observed across most anatomical regions (36 %–52 %). Agreement improved substantially when classifying injuries as minor or major (78 %–86 %). The overall concordance for determining the cause of death was 33.85 % using expert opinion (κ = 0.23) and 55.38 % using AIS scoring (κ = 0.41). PMCT showed high sensitivity in detecting skeletal injuries but was limited in identifying soft tissue damage and vascular lesions, particularly in the abdomen and external surface regions. Conclusion: PMCT demonstrates substantial agreement with autopsy in classifying injury severity, especially when guided by AIS scoring. While PMCT alone may not replace autopsy in all cases, its utility is enhanced through standardized injury scoring. PMCT may serve as a reliable adjunct or alternative in select forensic contexts, particularly where autopsy is declined or unavailable.