RADIOLOGICAL VS AUTOPSY FINDINGS IN GUNSHOT WOUND ASSESSMENT: A COMPARATIVE STUDY

Background: Gunshot wounds (GSWs) remain a significant public health and forensic concern in Pakistan, where firearm-related deaths are on the rise. Radiological imaging is emerging as a valuable adjunct to conventional autopsy in postmortem investigations. Objective: To compare autopsy and radiological findings in fatal Gunshot wounds cases in Islamabad. Methods: This retrospective study was conducted at the Department of Forensic Medicine and Radiology, HBS (Hazrat Bari Imam Sarkar) Medical and Dental College, Islamabad. The study was approved by the institutional ethical review board, and all procedures adhered to legal and ethical standards for research involving deceased individuals. The study covered 1-year period, from April 2024 to March 2025. A total of 68 medico-legal cases of firearm-related fatalities were selected through non-probability purposive sampling from DHQ Rawalpindi.Demographic data, radiological reports (primarily CT and X-rays), and autopsy findings were collected and analyzed for concordance. Statistical agreement was measured using the kappa coefficient. Results: Of the 68 cases, 79.4% were male, with a predominance in the 31–45-year age group (39.7%). Radiological imaging detected entry and exit wounds in 94.1% and 85.2% of cases, respectively, while autopsy confirmed 100% and 91.1%. Cranial fractures showed a 94.1% concordance, and the kappa value for overall agreement was 0.812, indicating substantial agreement. However, radiology missed several soft tissue and visceral organ injuries, especially liver and cardiac lesions. Conclusion: Radiological imaging, while not a substitute for autopsy, provides a valuable, non-invasive tool for documenting skeletal trauma, bullet trajectories, and retained projectiles