An analysis of cases identified as life-threatening injuries in forensic reports issued by the department of Forensic Medicine, Akdeniz University Faculty of Medicine between 2014 and 2023

One of the duties of physicians is to prepare forensic reports in cases of medicolegal significance. Forensic traumatology reports, which provide information on the severity of trauma-related injuries, are prepared in accordance with Articles 86, 87, 89, 94, and 95 of the Turkish Penal Code (TPC No. 5237). Cases in which an injury is considered to have posed a "life-threatening condition" are regarded as aggravating circumstances under Articles 87/1, 89/2, and 95/1 of the Turkish Penal Code. In this study, we retrospectively evaluated 1863 cases documented as involving life-threatening injuries in forensic reports prepared by the Department of Forensic Medicine at Akdeniz University Faculty of Medicine over a ten-year period from 2014 to 2023. Variables such as the requesting legal authority, age, sex, type of incident, etiology, anatomical regions injured, causes of the life-threatening condition, treatment interventions, presence of bone fractures or dislocations, permanent weakening or loss of the function of one of the senses or organs, and presence of a fixed mark on the face were examined from a medicolegal perspective. Among the 1863 cases included in the study, 81.7% (n=1523) were male and 18.3% (n=340) were female, with a mean age of 32.0 ± 18.01 years. The age group with the highest frequency of cases was 21–30 years (n=419, 22.5%). The most frequent months for incidents were September (n=185, 9.9%) and November (n=185, 9.9%), with autumn (n=552, 29.6%) being the most common season. In terms of etiology and incident type, accidents (n=1357, 72.9%) and traffic accidents (n=1032, 55.3%) were most common. Assault-related injuries were significantly more frequent among males, while accident- and self-inflicted injuries were more common among females. Sharp force injuries, firearm injuries, and physical assault were significantly more frequent among males, whereas traffic accidents and falls from height were significantly more frequent among females. Surgical treatment was applied in 49.1% of the cases (n=915), and 42.8% were hospitalized for medical treatment. Bone fractures or dislocations were present in 72.0% (n=1341) of the cases, with the highest rate (34.6%) in the neurocranial region. The likelihood of life-threatening injuries resulting in fractures or dislocations was significantly higher in females (77.1%), in accident-related cases (83.9%), and in incidents such as traffic accidents (89.3%) and falls from height (91.0%). Among the cases in which the permanent weakening or loss of the function of one of the senses or organs was evaluated, 53.8% were not found to have such a condition, 41.2% were classified as having permanent loss of function, and 5.0% were categorized as having permanent functional disability. Among those evaluated for the presence of fixed marks on the face, 9.7% were found to meet this criterion. The occurrence of permanent functional disability or permanent loss of function (n=73, 57.5%) and the presence of fixed marks on the face (n=18, 14.3%) were significantly higher in cases of traffic accidents. In our study, the most frequently injured region (70.3%) and the most common region associated with life-threatening injuries (51.6%) was the head and neck. Head and neck injuries were significantly more common in females (n=195, 20.3%), in accident-related injuries (n=814, 84.6%), and in cases involving traffic accidents (n=653, 63.3%), falls from height (n=130, 65.3%), and physical assaults (n=85, 83.3%). The most frequent causes of life-threatening conditions were identified as intracranial traumatic changes (n=772, 41.4%), hemothorax-pneumothorax-pneumomediastinum-air embolism (n=654, 35.1%), skull/skull base/orbital roof fractures (n=645, 34.6%), pulmonary contusion/laceration (n=595, 31.9%), major vascular injuries (n=174, 9.3%), liver injuries (n=166, 8.9%), and splenic injuries (n=149, 8.0%). In the 0–17 age group, intracranial traumatic changes (25.3%) and skull/skull base/orbital roof fractures (29.9%) were significantly more frequent, whereas in the 18–64 age group, thoracic injuries and vascular injuries were predominant. Intracranial traumatic changes (20.6%) and liver injuries (24.1%) were significantly higher in females, while major vascular injuries (88.5%) were significantly higher in males. This study aimed to assess life-threatening injuries from a medicolegal perspective and to identify the demographic, clinical, and forensic characteristics of such cases in which life-threatening status was explicitly stated in forensic reports. A comparative analysis with the literature was performed. The findings are intended to guide both forensic medicine practitioners and judicial authorities, contributing to a better understanding of the strengths and limitations encountered in injury-related reporting under the Turkish Penal Code. In this regard, the study sheds light on the practical implications of the concept of life-threatening injury and is expected to provide a valuable reference for future research on the subject.