Traumatopsy: A Unique Crash Reconstruction Method for Determining Injury Patterns in Fatal Motor Vehicle Crashes 2008-01-0519

BACKGROUND: Detailed fatal injury data following fatal motor vehicle crashes (MVC) are necessary to improve occupant safety and promote injury prevention. Autopsy remains the principle source of detailed fatal injury data. However, procedure rates are declining due to a range of technical, ethical and religious concerns. Postmortem computed tomography (PMCT) is a potential alternative or adjunct to autopsy which is increasingly used by forensic researchers. However, there are only limited data regarding the utility of PMCT for analysis of fatal MVC injuries. METHODS: We performed whole body PMCT, autopsy and complete crash reconstruction on 3 subjects fatally injured in MVC in a single county in Michigan. All injuries detected by either PMCT or autopsy were coded using the Abbreviated Injury Scale (AIS). Severe injuries, defined as AIS 3 or higher (AIS 3+), were tallied for each forensic procedure to allow a comparison of relative diagnostic performance. RESULTS: A total of 19 AIS 3+ injuries were identified by autopsy and PMCT for these cases. The addition of PMCT to autopsy increased overall detection of AIS 3+ injuries (all types) by 22%. CONCLUSIONS: Use of PMCT improves the detection of AIS 3+ injuries following fatal MVC compared with isolated use of autopsy and also produces a highly detailed permanent objective record. PMCT appears to improve detection of skeletal injury compared with autopsy but is less sensitive than autopsy for the detection of AIS 3+ soft tissue injuries. Neither autopsy or PMCT identified all AIS 3+ injuries revealed by the combination of the two methodologies. This pilot study suggests that PMCT should be used as an adjunct to autopsy rather than a replacement whenever feasible. PMCT in conjunction with accident reconstruction allows researchers to more easily establish injury patterns that are a direct result of the interaction of the subject and the vehicle.