Medicolegal evaluation of children examined between 2013 and 2022 at the forensic medicine department of Pamukkale University Faculty of Medicine

Children may apply to forensic medicine outpatient clinics due to many forensic events affecting their health such as beatings, traffic accidents, poisoning, all kinds of abuse and neglect. In addition, they are also referred to forensic medicine outpatient clinics for reasons such as disability assessment, bone age determination or assessment of criminal responsibility. Children, who are more vulnerable than adults, are more prone to traffic accidents and other accidents, especially all kinds of abuse and neglect. In our study, all archival records in the archive of Pamukkale University Faculty of Medicine, Department of Forensic Medicine between 2013 and 2022 were retrospectively reviewed (n=13326). The archive files were analyzed and 1991 pediatric cases with forensic medical evaluation were identified. The cases were grouped according to the type of report and the data determined according to the characteristics of the cases and reports were analyzed. Of the 1991 cases included in our study, 43.7% (n=871) were female, 56.3% (=1120) were male, and 1244 (62.5%) of the cases were injury cases. The number of cases examined for sexual abuse was 262. Blunt trauma accounted for 75.3% (n=937) of the injuries, followed by penetrating injuries with 13.3% (n=168) and poisoning cases with 10.3% (n=128). Traffic accidents accounted for 60.8% (n=570) of blunt traumas, followed by assault with 28.3% (n=279). In our study, 168 cases of penetrating injuries were identified, of which 88.7% (n=148) were males and 11.3% (n=20) were females. Of the 128 poisoning cases, 60.2% (n=77) were females and 39.8% (n=51) were males. When the distribution according to the substance causing poisoning was analyzed, it was observed that drug intoxication was the first with 49.2% (n=63), followed by ethanol intoxication with 14.8% (n=19) and corrosive substance ingestion with 12.5% (n=16). Blunt, penetrating, physical and blast injuries (n=1130); 55.5% (n=628) of the cases had head and neck injuries, 31.7% (n=359) had lower extremity injuries and 28.5% (n=322) had upper extremity injuries. Of the total 1991 cases included in the study, 13.2% (n=262) were examined for sexual abuse. Of these cases, 23.7% (n=62) were male and 76.3% (n=200) were female. The age group of 15-17 years, which constituted the majority of the cases (77.5%), was the most common age group. It was found that 40.8% (n=107) of the cases had vaginal penetration, 32.4% (n=85) had anal penetration, 3.1% (n=9) had oral penetration and 21.4% (n=56) had sexual abuse without penetration. The most common finding in the examination was intact hymens in 52.8% (n=103) of the cases. In 27.2% (n=53) of the cases, old laceration, in 5.1% (n=10) acute laceration and in 13.3% (n=26) the hymens were in a structure that would allow vaginal penetration without tearing. In anal examination, decreased sphincter tone, ecchymosis or abrasion on the anal mucosa and acute anal fissure findings were found more frequently in cases with a history of anal penetration. After more than 7 days, anal penetration findings that may be detected in examinations performed more than 7 days later were found to be significantly reduced. In conclusion, trauma is one of the leading preventable causes of childhood injuries. The majority of injury cases were blunt traumas and the majority of blunt traumas were caused by traffic accidents. It was determined that the most frequently injured body part and the most life-threatening injuries were head and neck injuries. A significant proportion of the cases were sexual abuse cases. The long admission periods of sexual abuse cases, which are mostly female cases, cause loss of findings that can be detected in the examination and constitute an important obstacle in the prevention of child sexual abuse. Key words: child, physical abuse, sexual abuse.