Comparing the diagnostic accuracy of post-mortem CT with invasive autopsy in fire-related deaths: a systematic review

Background: The value of post-mortem computed tomography (PMCT) in trauma victims is well established. In this review the diagnostic accuracy and value of PMCT will be investigated specifically for fire related deaths, which has yet to be fully investigated. Methods: PRISMA guidelines informed this systematic review. A total of ten databases were searched in December 2020. All articles exploring the use of PMCT and autopsy to investigate fire related deaths in adults were deemed eligible for inclusion, and were reviewed by two independent researchers. The QUADAS-2 tool was used to assess the quality of these papers. Results: Seven studies were selected, containing a total of 110 burns victims. PMCT was superior in identifying fractures, and is particularly accurate with regards to fractures and injuries of the skull, facial bones, neck and extremities. However, PMCT fared poorly in identifying signs of vitality during a fire compared to autopsy. Toxicological examinations to assess carbon monoxide levels were often still required to make a conclusive diagnosis of fire as the cause of death. Conclusions: Despite the heterogeneity of the methodologies' reviewed, it is clear that PMCT is an extremely powerful visualisation tool with great potential for documentation and examination in forensic cases. The limitations of PMCT mean that it can not fully replace autopsy in these cases, but if autopsy is not available PMCT, in combination with a toxicology and histology examination, can identify the cause of death to a high degree of certainty.