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BACKGROUND: Detailed fatal injury data following fatal motor vehicle crashes (MVC) are necessary to improve occupant safety and promote injury prevention. Autopsy remains the principle source of detailed fatal injury data. However, procedure rates are declining due to a range of technical, ethical and religious concerns. Postmortem computed tomography (PMCT) is a potential alternative or adjunct to autopsy which is increasingly used by forensic researchers. However, there are only limited data regarding the utility of PMCT for analysis of fatal MVC injuries. METHODS: We performed whole body PMCT, autopsy and complete crash reconstruction on 3 subjects fatally injured in MVC in a single county in Michigan. All injuries detected by either PMCT or autopsy were coded using the Abbreviated Injury Scale (AIS). Severe injuries, defined as AIS 3 or higher (AIS 3+), were tallied for each forensic procedure to allow a comparison of relative diagnostic performance.