Role of Multi-detector Computed Tomography in Medicolegal Evaluation of Non-Fatal Firearm Injuries in the Head in Assiut University Hospital

Background: Firearm injuries may cause physical disabilities, permanent infirmities, psychological harm or death of injured individuals. Multi-detector computed tomography (MDCT) became a mainstay noninvasive diagnostic tool in investigation of firearm injuries as it gives three dimensional imaging (3-D) and colored images. Objective: This study was designed to through light on the role of MDCT in medicolagal evaluation of non-fatal firearm injuries in the head which examined in Assiut University hospital. Subjects and Methods:  this study was conducted on 67 cases of non-fatal firearm injuries in the head including an age group 16-70 years which presented in the trauma unit and outpatient clinic of neurosurgery department during the period from June 2013 to June 2015. After forensic examination, the cases were examined blindly by two consultant radiologists using 16-row multi-detector CT in diagnostic radiology department of Assiut University hospital after giving an informed consent. The obtained images were post-processed using an advanced diagnostic computer workstation to obtain multi-planar reformatted and three-dimensional volume-rendered images to examine soft tissues, skull and intracranial structures. The relevant disclosing MDCT images were documented, interpreted and data were discussed between participants of the research from departments of the forensic medicine and diagnostic radiology and compared to results of forensic examination. Statistical analysis of data was done. Results: Most of injuries occurred in males which represented 89.45% of total cases and the highest percentage of victims was in the age group 21-30 years which represented 31.3%. MDCT images help in determining details of inlets and exits (in soft tissue, bone and intracranial structures), recognizing the type of used firearm weapons (weapons firing shots represented 73.1%), retained projectiles, determination of the distance of firing (79.1 % of total). In addition it demonstrated retained projectiles which represented 46.3% of total cases and their details (types, numbers, shapes, sizes, trajectory and deflection inside the skull), intracranial hemorrhage, edema, skull fractures. It can help in determination of permanent infirmity (which represented 17.9% of total cases) and in planning for surgical interference. Conclusion: This study demonstrated that MDCT is an accurate diagnostic tool in the medicolegal investigations of firearm injuries. The MDCT images are documented forensic evidence which can be stored, electronically sent for medicolegal consultation and can be shown in the court. In addition, medicolegal experts can trust on MDCT for determination of permanent infirmities which can help injured persons to obtain compensations and determine responsibility of physicians about faults in malpractice claims.