Radiological appraisal of moderate to severe head injury – Medicolegal implications

Document Type





Objective: To compare the diagnosis of X-ray and CT scan of skull in assigning the correct kind of moderate to severe head injury (Shajjah) for medicolegal (ML) certification, and also the clinical severity of head injury against the medicolegal severity. STUDY DESIGN: Comparative study.
Duration and setting: Medicolegal Section of Accidents and Emergency Department, Civil Hospital Karachi (CHK) and Radiology Department, Dow University of Health Sciences CHK, From June 2008 to May 2009.
Methods: One hundred cases of moderate to severe head injury based on Glasgow Coma score (GCS) of 12 or less, with fractured skull reported for medicolegal certification were included. Those with mild injury (GCS 12 or greater), without fracture of skull, with additional face injury, or non medicolegal cases were excluded. Plain X-rays and CT scan of skull and brain were performed in every case. Radiological findings, GCS, and demographics were noted. Shajjah injury types were assigned according to Qisas and Diyat Act terms. Findings of both modalities were compared for medicolegal and clinical severity of injuries and expressed in numbers and percentages.
Results: There were 54 cases of moderate and 46 cases of severe head injury. As against CT scan, plain X rays failed to reveal any injury in 21 cases later diagnosed on CT scan Hashimah (n=4), Munaqillah (n=04), Ammah (09) and Damighah (n=04) hurts. Additionally, X rays under diagnosed 60 cases of Shajjah hurts. Nine cases of Shajjah-i-Damighah were similarly diagnosed on X-ray and CT scan. The mean GCS score was 11.3 ± 4.1 in Hashimah, 9.4 ± 3.1 in Munaqillah, 7.8 ± 4.1 in Ammah and 8.6 ± 3.3 in Damighah hurt.
Conclusion: In comparison with plain X rays, CT scan had superior performance in correctly assigning the ML grade of head injury in the moderate to severely injured case. The cases with higher clinical severity (lower GCS core) did not necessarily have a higher medicolegal grade of injury.

Publication (Name of Journal)

Journal of Liaquat University of Medical and Health Sciences