Problems faced in the disability rate of cases with traumatic brain injury: A comparison of different regulations

Objective: One of the an important practices areas of forensic medicine is to prepare the disability ratio reports due to the sequelae remaining in people after traumatic injuries. There are more than one Regulation in use in our country on this subject. These reports can generally be examined under two headings as the Loss of Profitability Reports and the Disabled Health reports. There are serious differences between these two Regulations and therefore people with the same sequel can receive different rates with different Regulation accounts. In this study, only the cases with head trauma were discussed in order to reveal the differences and deficiencies in the Regulations used in the calculation of the disability ratios due to the sequelae due to injuries after traffic accidents. By comparing the ratios of the cases according to the two scales, it is aimed to reveal the differences and deficiencies and to emphasize the need to organize a chart that can be used jointly for traffic accidents. Materials and Methods: Among the cases whose disability report was prepared in Muğla Sıtkı Koçman University Forensic Medicine Department between 01.01.2017-31.12.2019, the reports of the cases whose disability report was issued due to head trauma were retrospectively re-examined. Data such as gender, age, accident type, injury type, examination findings, remaining sequelae were obtained from the findings recorded in the reports. According to the latest examination findings available in the reports, each case; within the scope of the Regulation on Determining the Rate of Loss of Working Power and Profitability, the rate of loss of working power and the whole body disability rate were recalculated within the scope of the Regulation on Disability Assessment for Adults. The differences in the sequelae in the head trauma section of both scales were discussed and a comparative statistical analysis was made in terms of the differences in the rates obtained for the same sequela, and the level of significance was accepted as p<0.05. Results: 251 (99.2%) of 253 head trauma cases were injured due to traffic accident and 2 (0.79%) were injured due to work accident. The majority of cases were young adults aged 20-39 (n=126, 49.8%), 70% were male (n=177), 30% were female (n=76). It has been observed that there are significant differences in the ratios according to both scales, and not every sequela is included in the scales. In practice, it has been observed that an increase or decrease is applied in order to achieve fairness and a harmony between the rates for the same sequelae in different scales. In the reports, it was observed that more discretionary reductions or increases were applied in the calculations of loss of earning power in the profession (83.4%). Conclusion: Serious differences in the Regulations and different rates even in the same case lead to grievances. For this reason, individuals can request a report to be prepared according to which scale they can get a higher rate from, which results in more than one report being issued in more than one center in practice. Such demands lead to a loss of credibility in forensic medical practice and are also wearisome for physicians. It would be very beneficial from a legal point of view to develop a common scale specific to traffic accidents, suitable for current traumatic injury models. Keywords: Forensic medicine; Loss of Working Power; Disability; Disablement; Head Traumas