Preliminary experience with postmortem computed tomography in military penetrating trauma

Background: Postmortem examination serves as a tool for confirmation of cli nical diagnosis, "quality" assurance, and education. In Israel, mostly beca use of religious reasons, most families withhold their permission to perfor m autopsies. To obtain objective information regarding the death of soldier s, the Israel Defense Forces Medical Corps started in September of 1997 to perform postmortem computed tomographic (PMCT) scans. The purpose of our st udy is to determine what information can be obtained from the PMCT scans. Methods: In a period of 16 months, 27 soldiers,were killed in low-intensity conflicts and PMCT was obtained in 22 cases. Medical data obtained from th e field medical care providers were collected and compared with PMCT result s. Results: Several examples of patients whose death was determined at the sce ne either before any medical intervention or after initiation of resuscitat ive treatment are shown in our study and compared with the clinical impress ion of the treating physician. Two examples of autopsy results are compared with PMCT results. Gas was detected in various parts of the circulatory sy stem in many cases. The significance of this finding, described in our stud y for the first time, needs further investigation. Conclusion: PMCT scanning has limits in detecting superficial injuries and injuries of the extremities and determining the exact route of fragments th rough body tissues in penetrating military trauma. It also cannot serve as a tool for examining ammunition or the protection provided by various armor s. However, it can provide a substantial amount of evidence that, when revi ewed with the clinical information obtained from the physician at the scene , can help in assessing the treatment given at the field and point toward t he probable cause of death.