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Article

Forensic Cases in the Emergency Department: Associations Between Life-Threatening Risk, Medical Treatability, and Patient Outcomes

by
Harun Yildirim
* and
Murtaza Kaya
Department of Emergency Medicine, Faculty of Medicine, Kutahya Health Sciences University, Kutahya 43100, Turkey
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(11), 1416; https://doi.org/10.3390/diagnostics15111416
Submission received: 2 May 2025 / Revised: 27 May 2025 / Accepted: 2 June 2025 / Published: 2 June 2025
(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

Abstract

:
Background: This study aimed to evaluate the clinical and forensic characteristics of cases admitted to a high-volume tertiary emergency department, focusing on severity-based classification using treatability with simple medical intervention (SMI) and life-threatening status. Methods: We retrospectively analyzed 3014 forensic cases over one year. Patients were classified based on injury severity, anatomical region, and clinical outcomes. Documentation practices and report types were also reviewed. Results: Among all the cases, 60.4% were treatable with SMI, and 10.5% were identified as life threatening. Notably, all patients who died (1.3% mortality) were in the life-threatening group, and none of the SMI-treated patients died, underscoring the accuracy of early triage and alignment between documentation and outcomes. Road traffic accidents were the leading cause of life-threatening injury and hospitalization, while assault cases were predominantly minor and managed conservatively. Seasonal variation peaked in July, and sex-based differences revealed a higher SMI eligibility among female patients. Final forensic reports were more frequently issued in SMI cases, while preliminary reports were predominant in severe trauma. Conclusions: Severity-based classification using SMI and life-threatening categories offers valuable insight for clinical decision-making and forensic documentation. Integrating structured triage, anatomical injury mapping, and standardized report templates can enhance both patient safety and legal reliability.

1. Introduction

Forensic cases refer to situations in which an individual’s physical or mental health is impaired due to another person’s intentional act, negligence, carelessness, or recklessness [1]. This definition encompasses the legal investigation of injuries or medical conditions and the determination of liability [2]. These include not only violent incidents such as road traffic accidents, assaults, and sexual violence, but also non-criminal assessments such as age estimation, custody-related evaluations, substance use detection, and document forgery investigations [3,4].
Emergency departments (EDs) serve as critical points for both urgent medical care and medico-legal processing [5]. Physicians in this setting are expected to provide clinical management while simultaneously fulfilling legal obligations such as injury documentation and forensic reporting to judicial authorities [6,7]. Key details—including injury type, size, location, orientation, time of occurrence, and healing timeline—must be documented thoroughly. Forensic reports are generally issued in two forms: preliminary and final. While preliminary reports are used for initial assessments, incomplete or hastily prepared versions without a detailed clinical evaluation may result in missed forensic findings and legal disadvantages for victims [8,9].
International studies highlight similar challenges. For instance, research from Saudi Arabia revealed that although 84.7% of emergency physicians were aware of the obligation to report forensic cases, 42.4% lacked adequate knowledge on how to prepare these reports properly—underscoring the need for standardized training in forensic documentation [10].
This study aims to evaluate the forensic case management and documentation practices in EDs and assess their implications on legal responsibility. By identifying deficiencies and patterns, the study seeks to support the development of improved training modules and practical guidelines for healthcare professionals.

2. Materials and Methods

2.1. Study Settings

This retrospective, descriptive, cross-sectional study was conducted in the ED of a tertiary care hospital in Turkey, which receives approximately 250,000 emergency admissions annually. The ED functions as a primary referral center and is responsible for the initial clinical and forensic assessment of cases requiring medico-legal documentation.

2.2. Data Source and Study Population

All patients classified as forensic cases who presented to the ED between 1 January 2023 and 31 December 2023 were retrospectively evaluated. Data were extracted from the hospital information management system, ED records, and official forensic report forms completed at admission. A total of 3281 patients were initially screened. After applying exclusion criteria—including non-forensic classifications, missing or inaccessible data, absence of active complaints or physical findings (n = 118), cases brought in solely for alcohol or substance screening (n = 85), and individuals admitted for custody-related procedures (n = 64)—a total of 3014 cases were included in the final analysis (Figure 1).

2.3. Variable Definitions

This study evaluated several variables including patient demographics (age, gender), seasonal trends in admissions, types of incidents resulting in forensic classification (e.g., traffic accidents, assaults), affected anatomical regions, applicability of simple medical intervention (SMI), presence of life-threatening injuries, type of forensic report issued (preliminary, final, or not issued), ED outcomes (discharge, hospitalization, referral, refusal, or death), hospital department of admission, and one-month mortality. SMI applicability and life-threatening condition were treated as independent classifications, with some non-SMI cases representing moderate but non-life-threatening injuries.

2.4. Statistical Analysis

All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software, version 27.0.1 (IBM Corp., Armonk, NY, USA). Descriptive statistics are presented as mean values and standard deviations for continuous variables, and as frequencies and percentages for categorical variables. The Shapiro–Wilk test was used to assess the normality of distribution for continuous variables. Based on the distribution characteristics, Student’s t-test was applied to compare the means of normally distributed continuous variables, such as age, between groups. The chi-square test was used to compare categorical variables such as gender, affected body regions, and the type of forensic report in relation to the applicability of SMI and the presence of life-threatening conditions. In cases where the expected cell counts were low, particularly in the analysis of mortality outcomes, Fisher’s exact test was employed. Binary logistic regression analysis was performed to identify independent predictors of mortality, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. A p-value of less than 0.05 was considered statistically significant.

2.5. Ethical Considerations

This study was approved by the Non-Interventional Clinical Research Ethics Committee of Kütahya Health Sciences University (Approval No: 2024/02-15, dated 13 February 2024). All procedures adhered to the principles outlined in the Declaration of Helsinki. Due to the retrospective and anonymized nature of this study, the requirement for informed consent was waived.

2.6. Legal and Regulatory Framework

In accordance with Article 87 of the Turkish Penal Code (Law No. 5237), which came into force in June 2005, emergency physicians in Turkey are legally required to evaluate and report forensic cases using two primary criteria: (1) life-threatening condition—whether the injury poses a risk to the individual’s life, and (2) SMI—whether the injury can be treated with minimal medical care without requiring hospitalization or advanced procedures. These criteria are central to the legal classification of assault-related injuries and directly affect judicial decisions regarding the severity of the offense and corresponding penalties. To promote consistency, a national guideline titled “The Forensic Medical Assessment Guide on Injury Offenses Defined in the Turkish Penal Code” was developed by the Council of Forensic Medicine, the Turkish Association of Forensic Medicine Specialists, and the Forensic Medicine Association. The most recent version of this guide was published in June 2019 and is widely used in EDs in Turkey [11].

3. Results

The mean age of the patients was 32.9 ± 17.9 years. Males constituted the majority of the cases (67.3%). Seasonal distribution showed that the highest frequency of admissions occurred during the summer months (29.8%), followed by autumn (28.3%), winter (23.6%), and spring (18.3%). In terms of outcomes in the ED, 76.3% of patients were discharged, 16.5% were admitted to the hospital, 5.8% refused treatment, 1.1% were referred to other hospitals, and 0.3% died during their ED stay. Among all the cases, 60.4% were classified as treatable with SMI, while 39.6% were not. Life-threatening conditions were present in 10.5% of the cases (Table 1).
Traffic accidents were by far the most frequent cause of forensic evaluation, followed by assault and work-related injuries. This reflects the high incidence of trauma-related presentations within forensic case evaluations in emergency settings and underlines the need for efficient triage protocols and injury documentation systems (Figure 2).
Rates of SMI and life-threatening conditions varied significantly according to the type of incident. Among traffic accidents (n = 1436), 936 (65.2%) were treatable with SMI and 119 (8.3%) were life threatening. Assault cases (n = 683) also constituted a significant portion, with 80.7% being SMI-treatable and 0.9% categorized as life threatening. The third most common group was falls (n = 173), of which 39.3% were not treatable with SMI and 23.1% were life threatening. These three categories—traffic accidents, assaults, and falls—represented the most common reasons for forensic presentation and contributed substantially to the overall trauma burden in the ED (Table 2).
Regarding clinical outcomes, 76.3% of the patients were discharged from the ED, while 16.5% required hospitalization. Among the hospitalized patients, admissions were primarily to surgical departments such as orthopedics, neurosurgery, and general surgery. Notably, 159 patients (approximately 3.4%) were admitted to the intensive care unit, reflecting the severity of certain presentations. Additionally, 1.1% of the patients were referred to other hospitals, 5.8% refused treatment, and 0.3% died during their hospital stay. These findings illustrate the diverse clinical spectrum of forensic cases and underscore the substantial burden they place on acute care resources (Figure 3).
Female patients were significantly more likely to be treated with SMI (67.5% vs. 57.0%, p < 0.001). Patients with multiple body system injuries were significantly more likely to require advanced treatment beyond SMI (60.6% vs. 39.4%, p < 0.001). This finding highlights the importance of comprehensive trauma evaluation, especially in cases involving polytrauma. Furthermore, all 39 patients who died within one month of presentation were in the non-SMI group. This supports the notion that the requirement for interventions beyond SMI is a strong predictor of poor prognosis (Table 3).
Older age was significantly associated with the presence of life-threatening injuries (mean 37.8 vs. 32.3 years, p < 0.001). All 39 mortality cases were in the life-threatening group (p < 0.001). Among patients in the life-threatening category, the most frequently affected body region was multiple body systems (n = 205, 65.1%). Among life-threatening cases, 95.2% (300/315) received preliminary reports, while only 1.6% (5/315) received final reports, indicating a strong association between injury severity and the preference for issuing preliminary reports (p < 0.001). These results underscore the value of early identification of life-threatening trauma, which is crucial for timely interventions and appropriate legal documentation (Table 3).
Binomial logistic regression analysis was conducted to identify predictors of mortality among forensic cases. The overall model was statistically significant (χ2(3) = 101, p < 0.001), with a Nagelkerke R2 of 0.256, indicating that approximately 25.6% of the variance in mortality was explained by the model. Among the predictors, age was found to be a significant factor (p < 0.001), with each additional year increasing the odds of mortality by 4% (OR = 1.04, 95% CI: 1.02–1.06). Hospital admission was also significantly associated with higher mortality risk (p < 0.001); admitted patients were 16.76 times more likely to die compared to those who were not hospitalized (OR = 16.76, 95% CI: 2.02–3.62). In contrast, sex was not a significant predictor of mortality (p = 0.117), indicating that the observed association between admission and mortality was independent of sex (Table 4).

4. Discussion

This study provides a comprehensive evaluation of forensic cases in a high-volume tertiary ED, highlighting the complex interplay between clinical management and judicial obligations. Emergency physicians are not only responsible for timely stabilization but also for accurate injury documentation, case classification, and legal reporting. Previous studies have shown that incomplete or inconsistent documentation may delay legal processes and weaken the judicial value of medical evidence [2,12].
Numerous studies have consistently reported a male predominance among forensic emergency cases, often concentrated in the young adult age group. For instance, Siddappa et al. noted that 71.8% of cases were male, with the highest incidence in the 21–30 age range (37.7%) [13]. Similarly, Malik et al. found that 81% of patients were male, with nearly three-quarters under 30 years of age [14]. These findings suggest that young, economically active males are more vulnerable due to increased exposure to traffic, hazardous work environments, and interpersonal violence. Our findings were consistent with this pattern: 67.3% of our patients were male, with a mean age of 32.9 years, underscoring the heightened medico-legal risk among this demographic.
The type of forensic cases presenting to EDs varies across geographic and socioeconomic contexts. Jadoon et al. identified traffic accidents (38.3%) and blunt trauma (27.3%) as leading causes in Pakistan [15], whereas Shreedhar et al. reported poisoning (40%) and traffic accidents (31.1%) as the most common in India [16]. In Turkey, Bıçakçı et al. found traffic accidents (33.3%), assault (24.1%), and occupational injuries (21.5%) to be the most prevalent [4]. In our study, traffic accidents constituted nearly half of all cases (47.7%), followed by assaults (22.7%) and work-related injuries (8.4%), which aligns more closely with Bıçakçı’s findings. This distribution may be influenced by urban density, transportation habits, industrial safety standards, and local legal reporting practices.
Seasonal trends have also been reported in forensic admissions, with several studies identifying increased case volumes in the summer months. Aydın et al. documented that 29.9% of forensic cases presented during summer [17], while Kapçı et al. similarly highlighted July, August, and September as peak months [18]. These seasonal peaks may be associated with higher mobility, outdoor activity, and increased interpersonal interactions during warmer weather. Our data mirrored this trend, with summer accounting for 29.8% of all forensic ED admissions. Recognizing this seasonal concentration may assist in resource allocation, such as augmenting staff and ensuring sufficient trauma capacity during high-incidence months.
The treatability of injuries with SMI varies by injury mechanism and anatomical involvement. Timsinha et al. reported that while most injuries involved extremities and were considered simple, the mortality rate still exceeded 8% [19]. Seviner et al. reported a life-threatening condition rate of 21.1% [20]. Within our sample, life-threatening injuries were identified in 10.5% of cases, and 39.6% were not treatable with SMI. Multisystem injuries were particularly associated with high life-threatening rates (26.9%) and low SMI-suitability (39.4%). In contrast, injuries limited to the extremities, head–neck, or torso were mostly non-life-threatening and often manageable with basic medical care. These findings highlight the need for structured anatomical assessment to inform both clinical urgency and medico-legal classification.
High rates of preliminary forensic reports have been consistently documented across EDs. Yemenici et al. reported that 68.7% of forensic reports were issued as preliminary documents [8], while Eroğlu et al. observed extreme inter-hospital variability, with temporary report rates ranging from 58.5% up to 99.6%, often shaped by institutional norms and physician habits [21]. Akbaba et al. further noted that temporary reports were frequently issued even in high-impact injuries such as traffic accidents and penetrating trauma, frequently without clear medical or legal justification—highlighting the disconnect between emergency physicians’ assessments and those of forensic medicine specialists [22]. Consistent with these findings, preliminary reports were issued in 67.3% of cases, while only 32.7% received definitive forensic documentation. This pattern not only mirrors previous findings but also underscores an ongoing reliance on provisional evaluations in emergency settings. Such practices may stem from clinical workload, medico-legal uncertainty, or lack of forensic training, but they carry significant risks—delaying judicial proceedings, weakening the evidentiary value of medical documentation, and potentially undermining victims’ access to justice.
Hospital admission rates among forensic cases reported in the literature vary considerably, often depending on the severity spectrum of included injuries. Aslaner et al. reported a hospitalization rate of 6.6% among forensic cases presenting to a secondary care hospital, with even lower rates (2.6%) among those with repeated ED visits, largely attributed to minor injuries such as interpersonal violence [23]. Similarly, Yüzbaşıoğlu et al. found a 5.8% admission rate in a refugee population, with most cases managed on an outpatient basis [24]. These lower rates likely reflect cohorts dominated by less severe presentations or barriers to care such as socioeconomic or legal status. In contrast, our study reported a hospital admission rate of 16.5%, indicating a comparatively higher injury burden. This discrepancy may reflect the inclusion of a broader range of high-energy injuries—particularly falls, suicide attempts, and occupational trauma—often requiring multidisciplinary inpatient care. Most admitted patients in our cohort were referred to surgery, orthopedics, or neurosurgery, highlighting the need for specialized trauma care in forensic cases with significant physiological impact.
Mortality rates reported in forensic emergency populations have shown considerable heterogeneity across studies and settings. In a tertiary hospital in North India, Mir et al. reported an in-hospital mortality rate of 11.7% among medico-legal cases, with a high proportion of severe trauma and delayed presentations likely contributing to this figure [25]. Kumar et al. documented a mortality rate of 4.15%, with road traffic accidents and blunt force injuries identified as the primary contributors [26]. These elevated rates may reflect limitations in prehospital care access, delayed intervention, or higher overall trauma acuity in those settings. In our cohort, the 1-month mortality rate was 1.3%, which is comparatively lower. Fatalities were mostly attributed to high-energy mechanisms, including traffic accidents (n = 18), falls (n = 9), suicide attempts (n = 2), and work-related injuries (n = 5). Notably, there were no deaths following stab/cut wounds, gunshot injuries, or burns—possibly indicating earlier intervention or lower injury severity in these categories. Our exclusion of brought-in-dead cases and late post-discharge deaths may also partially explain the lower mortality rate. Together, these findings emphasize the role of early access to definitive trauma care and system-level responsiveness in reducing preventable deaths in forensic populations.

5. Limitations

This study has several limitations that should be acknowledged. First, the retrospective design may introduce selection and information bias, as data collection was based on routine medical and forensic records, which may contain omissions or inconsistencies. Additionally, evaluator variability among emergency physicians and the time-sensitive nature of forensic documentation may have affected the completeness and consistency of the data. Second, although the sample size is large, this study reflects the experience of a single tertiary center and may not fully represent national patterns. Moreover, long-term outcomes, such as legal adjudication results or long-term functional disability, were not captured due to data access constraints. Lastly, while this study classified injury severity based on clinical presentation and disposition, no standardized scoring system was used, which may affect reproducibility across different institutions.

6. Conclusions

This study presents a detailed examination of the clinical and legal characteristics of forensic cases admitted to a tertiary ED. By utilizing nationally recognized medico-legal criteria—such as the presence of life-threatening injuries and the applicability of SMI—we demonstrated that case classification is not only legally relevant but also associated with important clinical outcomes, including hospitalization and mortality. The observed consistency between physicians’ assessments and legal documentation highlights the dual responsibility of emergency professionals in both clinical management and judicial accuracy. These findings emphasize the importance of improving forensic awareness and documentation practices among emergency physicians. National policies and training programs tailored to medico-legal responsibilities in emergency care may contribute to better patient outcomes and greater legal reliability.

Author Contributions

Conceptualization, H.Y. and M.K.; Methodology, H.Y. and M.K.; Software, H.Y. and M.K.; Validation, M.K.; Formal analysis, M.K.; Investigation, H.Y. and M.K.; Resources, H.Y.; Data curation, H.Y. and M.K.; Writing—original draft preparation, H.Y. and M.K.; Writing—review and editing, H.Y. and M.K.; Visualization, M.K.; Supervision, H.Y. and M.K.; Project administration, H.Y.; Funding acquisition, H.Y. and M.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

All authors declare that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki’s “Ethical Principles for Medical Research Involving Human Subjects”. This study was approved by the Non-Interventional Clinical Research Ethics Committee of Kütahya Health Sciences University (Approval No: 2024/02-15, dated 13 February 2024).

Informed Consent Statement

Not applicable because this study was based on medical record review, and no individual information appeared in this study.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to privacy.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

SMISimple medical intervention
EDEmergency department
LTCLife-threatening condition
HHospitalized
MOMortality
MMale
FFemale

References

  1. Terece, C.; Kocak, A.; Soğukpınar, V.; Gürpınar, K.; Aslıyüksek, H. Evaluation of forensic reports issued in emergency departments and comparison with reports issued by the Council of Forensic Medicine. Ulus Travma Acil Cerrahi Derg. 2022, 28, 140–146. [Google Scholar] [CrossRef] [PubMed]
  2. Madadin, M.; Alqarzaie, A.A.; Alzahrani, R.S.; Alzahrani, F.F.; Alqarzea, S.M.; Alhajri, K.M.; Al Jumaan, M.A. Characteristics of medico-legal cases and errors in medico-legal reports at a teaching hospital in Saudi Arabia. Open Access Emerg. Med. 2021, 13, 467–473. [Google Scholar] [CrossRef] [PubMed]
  3. Brahmankar, T.; Sharma, S. A record based study of frequency and pattern of medico-legal cases reported at a tertiary care hospital in Miraj. Int. J. Community Med. Public Health 2017, 4, 1348–1352. [Google Scholar] [CrossRef]
  4. Bıçakçı, S.; Bıçakçı, N.; Şahin, H.; Saka, N.E.; Çamci, E. A retrospective one-year review of forensic reports filed in the emergency department. Namik Kemal Med. J. 2024, 12, 115–121. [Google Scholar]
  5. Peel, M. Opportunities to preserve forensic evidence in emergency departments. Emerg. Nurse 2016, 24, 20–26. [Google Scholar] [CrossRef]
  6. Alpaslan, M.; Baykan, N. Analysis of patients evaluated for forensic reasons in the emergency department and the burden of battery and assault examinations on emergency care. J. Med. Sci. 2025, 6, 9–16. [Google Scholar]
  7. De, L.M.; Jacobs, W. Forensic emergency medicine: Old wine in new barrels. Eur. J. Emerg. Med. 2010, 17, 186–191. [Google Scholar]
  8. Eroğlu, S.; Toprak, S.; Karataş, A.; Onur, Ö.; Özpolat, Ç.; Salçın, E.; Denizbaşı, A. What is the meaning of temporary forensic reports for emergency physicians? Turk. J. Emerg. Med. 2013, 13, 13–18. [Google Scholar] [CrossRef]
  9. Smith, J.; Lemay, K.; Lee, S.; Nuth, J.; Ji, J.; Montague, K.; Garber, G.E. Medico-legal issues related to emergency physicians’ documentation in Canadian emergency departments. Can. J. Emerg. Med. 2023, 25, 768–775. [Google Scholar] [CrossRef]
  10. Alabdulqader, S.; Alabdulqader, R.; Madadin, M.; Kashif, H.; Al Jumaan, M.A.; Yousef, A.A.; Menezes, R.G. Emergency physicians’ awareness of medico-legal case management: A cross-sectional study from Saudi Arabia. Saudi J. Med. Med. Sci. 2023, 11, 10–15. [Google Scholar] [CrossRef]
  11. Balcı, Y.; Çolak, B.; Gürpınar, K.; Anolay, N. Guide to the Forensic Medical Evaluation of Injury Offenses Defined in the Turkish Penal Code, 2nd ed.; Adli Tıp Uzmanları Derneği: Ankara, Turkey, 2019. Available online: https://www.atk.gov.tr/tckyaralama24-06-19.pdf (accessed on 17 April 2025).
  12. Aktas, N.; Gulacti, U.; Lok, U.; Aydin, I.; Borta, T.; Celik, M. Characteristics of the traumatic forensic cases admitted to emergency department and errors in the forensic report writing. Bull. Emerg. Trauma 2018, 6, 64–70. [Google Scholar] [CrossRef] [PubMed]
  13. Siddappa, S.; Datta, A. A study pattern of medico-legal cases treated at a tertiary care hospital in central Karnataka. Indian J. Forensic Community Med. 2015, 2, 193–197. [Google Scholar] [CrossRef]
  14. Malik, R.; Atif, I.; Rashid, F.; Abbas, M. An analysis of 3105 medico legal cases at tertiary care hospital, Rawalpindi. Pak. J. Med. Sci. 2017, 33, 926–930. [Google Scholar] [CrossRef]
  15. Jadoon, O.K.; Shireen, F.; Seema, N.; Afzal, E.; Ahmad, I.; Irshad, R.; Sattar, H. Types of medico-legal cases reported at the casualty department of Ayub Teaching Hospital Abbottabad. J. Ayub Med. Coll. Abbottabad 2020, 32, 51–53. [Google Scholar] [PubMed]
  16. Shreedhar, N.C.; Chandan, V.; Shreekrishna, H.K. Retrospective study of profile of medico-legal cases at Basaveshwara medical college, Chitradurga. Med. Legal Update 2021, 21, 348–355. [Google Scholar] [CrossRef]
  17. Aydın, M.; Uzun, Ş.C. Evaluation of forensic cases admitted to the emergency department: A retrospective analysis. Gümüşhane Sağlık Bilim. Derg. 2023, 12, 882–888. [Google Scholar] [CrossRef]
  18. Kapçı, M.; Türkdoğan, K.; Akpınar, O.; Duman, A.; Bacakoğlu, G. Demographic analysis of forensic cases evaluated in the emergency department. J. For. Med. 2015, 29, 67–74. [Google Scholar] [CrossRef]
  19. Timsinha, S.; Parajuli, S. Mechanical injury among medicolegal cases in the department of emergency in a tertiary care centre: A descriptive cross-sectional study. JNMA J. Nepal Med. Assoc. 2022, 60, 1000–1003. [Google Scholar] [CrossRef]
  20. Seviner, M.; Kozacı, N.; Ay, M.; Açıkalın, A.; Çökük, A.; Gülen, M.; Acehan, S.; Karanlık, M.G.; Satar, S. A retrospective analysis of forensic cases presenting to the emergency medicine clinic. Çukurova Univ. Med. Fac. J. 2013, 38, 250–260. [Google Scholar]
  21. Yemenici, S.; Sayhan, M.B.; Salt, Ö.; Yılmaz, A. Evaluation of forensic reports prepared in the emergency department. Harran Univ. Med. Fac. J. 2017, 14, 179–186. [Google Scholar]
  22. Akbaba, M.; Das, V.; Asildag, M.K.; Karasu, M.; Atan, Y.; Tataroğlu, Z.; Kul, S. Are the judicial reports prepared in emergency services consistent with those prepared in forensic medicine department of a university hospital? Eurasian J. Emerg. Med. 2019, 18, 79–85. [Google Scholar] [CrossRef]
  23. Aslaner, M. Revisits of forensic cases to the emergency department. J. Forensic Leg. Med. 2019, 65, 81–85. [Google Scholar] [CrossRef] [PubMed]
  24. Yüzbaşıoğlu, Y.; Çıkrıkçı, I.G. Retrospective analysis of forensic cases in refugees admitted to emergency department. Am. J. Emerg. Med. 2019, 37, 1691–1693. [Google Scholar] [CrossRef] [PubMed]
  25. Mir, M.; Ahmad, A.; Ahmad, S.; Jan, F.A.; Yatoo, G.H.; Khalil, I.; Ganai, S.; Irshad, H. Profile and pattern of medico-legal cases in a tertiary care hospital of North India. J. Med. Sci. Clin. Res. 2016, 4, 12628–12634. [Google Scholar]
  26. Kumar, R.; Jena, S.; Singh, M.; Naik, S.; Prakash, A.; Singh, S. Profile of medico-legal cases in accident and emergency department of SSKH, LHMC, New Delhi during pre-COVID-19 and COVID-19 periods. Eur. J. Med. Health Sci. 2023, 5, 20–25. [Google Scholar] [CrossRef]
Figure 1. Flowchart of patient selection and inclusion criteria. SMI: simple medical intervention.
Figure 1. Flowchart of patient selection and inclusion criteria. SMI: simple medical intervention.
Diagnostics 15 01416 g001
Figure 2. Percentage distribution of forensic cases according to incident type.
Figure 2. Percentage distribution of forensic cases according to incident type.
Diagnostics 15 01416 g002
Figure 3. Numerical distribution of hospitalized patients across clinical departments.
Figure 3. Numerical distribution of hospitalized patients across clinical departments.
Diagnostics 15 01416 g003
Table 1. Demographic characteristics of the patients.
Table 1. Demographic characteristics of the patients.
Age (Mean ± SD)32.9±17.9
Sex n (%)Male202867.3
Female98632.7
Seasonal Distribution
n (%)
Spring55318.3
Summer89729.8
Autumn85328.3
Winter71123.6
Outcome in ED
n (%)
Discharged229976.3
Admitted to Hospital49816.5
Refused the Treatment1745.8
Referral to Another Hospital341.1
Died in ED90.3
Life-Threatening Condition?Yes31510.5
No269989.5
Simple Medical InterventionTreatable182160.4
Not Treatable119339.6
ED: emergency department; Spring: March, April, May; Summer: June, July, August; Autumn: September, October, November; Winter: December, January, February.
Table 2. Distribution of forensic cases by incident type: demographics, clinical severity, and outcomes.
Table 2. Distribution of forensic cases by incident type: demographics, clinical severity, and outcomes.
SEXAGESMILTCHMO
n (%)M
2028
(67.3)
F
964
(32.7)
MeanYes
1821 (60.4)
No
1193 (39.6)
Yes
315
(10.5)
No
2699
(89.5)
(+)
498
(16.5)
(+)
39
(1.3)
Traffic Accident964
(32.0)
472
(15.7)
33.1936 (31.1)500 (16.6)119 (3.9)1317 (43.7)245
(8.1)
18
(0.6)
Assault427
(14.2)
256
(8.5)
32.3551 (18.3)132 (4.4)6 (0.2)677 (22.5)20
(0.7)
0
(0)
Work Accident220
(7.3)
33
(1.1)
35.7114 (3.8)139 (4.6)19 (0.6)234 (7.8)46
(1.5)
5
(0.2)
Fall117
(3.9)
56
(1.8)
33.568
(2.3)
105 (3.5)40 (1.3)133 (4.4)65
(2.2)
9
(0.3)
Stab/Cut Injury131
(4.3)
27
(0.9)
28.551
(1.7)
107 (3.6)27 (0.9)131 (4.3)36
(1.2)
0
(0)
Poisoning27
(0.9)
35
(1.2)
38.542
(1.4)
20
(0.7)
11 (0.4)51 (1.7)7
(0.2)
0
(0)
Suicide Attempt62
(2.0)
71
(2.4)
31.019
(0.6)
114 (3.8)67 (2.2)66 (2.2)54
(1.8)
2
(0.1)
Burn22
(0.7)
19
(0.6)
20.715
(0.5)
26
(0.9)
9 (0.3)32 (1.1)9
(0.3)
0
(0)
Substance/Alcohol18
(0.6)
4
(0.1)
33.510
(0.3)
12
(0.4)
6 (0.2)16 (0.5)4
(0.1)
2
(0.1)
Electrical Injury9
(0.3)
4
(0.1)
34.56
(0.2)
7
(0.2)
2 (0.1)11 (0.4)0
(0)
0
(0)
Sexual Assault2
(0.1)
3
(0.1)
24.83
(0.1)
2
(0.1)
0
(0)
5 (0.2)0
(0)
0
(0)
Animal Attack6
(0.2)
3
(0.1)
41.73
(0.1)
6
(0.2)
1 (0.0)8 (0.3)3
(0.1)
0
(0)
Drowning3
(0.1)
1
(0)
33.32
(0.1)
2
(0.1)
2 (0.1)2 (0.1)1
(0)
1
(0)
Gunshot Injury18
(0.6)
2
(0.1)
39.01
(0)
19
(0.6)
4 (0.1)16 (0.5)8
(0.3)
0
(0)
Suspicious Death2
(0.1)
0
(0)
71.00
(0)
2
(0.1)
2 (0.1)0
(0)
0
(0)
2
(0.1)
SMI: simple medical intervention; LTC: life-threatening condition; H: hospitalized; MO: mortality; M: male; F: female.
Table 3. Comparison of forensic case characteristics by SMI eligibility and life-threatening risk.
Table 3. Comparison of forensic case characteristics by SMI eligibility and life-threatening risk.
n (%)Treatable with SMI
1821 (60.4)
Not Treatable with SMI
1193 (39.6)
p-ValueLife Threatening: YES
315 (10.5)
Life Threatening: NO
2699 (89.5)
p-Value
SexMale1155 (57.0)873 (43.0)<0.001 a214 (10.6)1814 (89.4)0.795 a
Female666 (67.5)320 (32.5)101 (10.2)885 (89.8)
Age31.2 ± 17.335.4 ± 18.4<0.001 b37.8 ± 20.032.3 ± 17.5<0.001 b
MortalityYes0 (0)39 (100)<0.001 c39 (100)0 (0)<0.001 c
No1821 (61.2)1154 (38.8)276 (9.3)2699 (90.7)
Affected Body Region
Head, Neck, and Face561 (71.4)225 (28.6)<0.001 a48 (6.1)738 (93.9)<0.001 a
Chest and Back157 (66.2)80 (33.8)21 (8.9)216 (91.1)
Abdomen, Pelvic, and Genital Regions97 (53.6)84 (46.4)24 (13.3)157 (86.7)
Upper and/or Lower Extremities706 (67.3)343 (37.2)17 (1.6)1032 (98.4)
Multiple Body Systems300 (39.4)461 (60.6)205 (26.9)556 (73.1)
Forensic Report Type
Preliminary Report574 (32.9)1171 (67.1)<0.001 a300 (17.2)1445 (82.8)<0.001 a
Final Report1242 (99.6)5 (0.4)5 (0.4)1242 (99.6)
Not Issued5 (22.7)17 (77.3)10 (45.5)12 (54.5)
a: chi-square test, b: Student’s t-test, c: Fisher’s exact test, SMI: simple medical intervention.
Table 4. Logistic regression results for mortality. Model coefficients—mortality.
Table 4. Logistic regression results for mortality. Model coefficients—mortality.
PredictorEstimateLower CIUpper CIp-ValueOdds Ratio
Intercept−7.524−8.59−6.45<0.0015.40
Age0.0390.020.05<0.0011.04
Hospitalized2.8192.023.61<0.00116.76
Sex0.540−0.131.210.1171.72
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Yildirim, H.; Kaya, M. Forensic Cases in the Emergency Department: Associations Between Life-Threatening Risk, Medical Treatability, and Patient Outcomes. Diagnostics 2025, 15, 1416. https://doi.org/10.3390/diagnostics15111416

AMA Style

Yildirim H, Kaya M. Forensic Cases in the Emergency Department: Associations Between Life-Threatening Risk, Medical Treatability, and Patient Outcomes. Diagnostics. 2025; 15(11):1416. https://doi.org/10.3390/diagnostics15111416

Chicago/Turabian Style

Yildirim, Harun, and Murtaza Kaya. 2025. "Forensic Cases in the Emergency Department: Associations Between Life-Threatening Risk, Medical Treatability, and Patient Outcomes" Diagnostics 15, no. 11: 1416. https://doi.org/10.3390/diagnostics15111416

APA Style

Yildirim, H., & Kaya, M. (2025). Forensic Cases in the Emergency Department: Associations Between Life-Threatening Risk, Medical Treatability, and Patient Outcomes. Diagnostics, 15(11), 1416. https://doi.org/10.3390/diagnostics15111416

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