A medico-legal assessment of forensic cases involving individuals under 18 admitted to Akdeniz University Hospital (2021-2023)

Childhood (under the age of 18) is a period during which individuals undergo ongoing biological, psychological, and social development, rendering them more vulnerable to trauma. Injuries are a significant cause of morbidity and mortality in this age group, and the World Health Organization (WHO) reports that injuries constitute a major cause of death among children aged 0–18 years. Medico-legal cases encompass not only incidents involving direct criminal acts, such as abuse or assault, but also injuries resulting from falls from height, drug or substance intake, burns, poisoning, suicide attempts, and neglect. These cases are usually first identified during emergency department visits, where they are documented and evaluated, playing a critical role in both medical management and legal proceedings. This cross-sectional, retrospective study analyzed medicolegal cases involving individuals under 18 years of age who presented to the Adult and Pediatric Emergency Departments of Akdeniz University Faculty of Medicine Hospital between January 1, 2021, and December 31, 2023. A total of 2,601 cases were included. Demographic characteristics, reasons for admission (e.g., falls, burns, poisoning, abuse), treatment processes, and data of medicolegal reports (presence of life-threatening conditions and treatability with simple medical intervention) were evaluated. Of the cases, 58.9% were male (n=1,532) and 41.1% were female (n=1,069). Adolescents (12–17 years) comprised the largest age group (28.4%), followed by the toddler/preschool age group (1–2 years) at 28.0%. The median age was 5.0 years in boys and 4.0 years in girls. Most cases (87.9%) resided in Antalya, and the majority of incidents occurred at home (59.1%). Emergency admissions were most frequent during summer (28.3%) and evening hours (17:00–23:59, 50.34%). Among the 2,601 pediatric forensic cases presenting to the emergency department, the three most commonly reported incident types were: foreign body in body cavities (15.0%), poisonings (14.9%), and falls (14.3%). These were followed by asphyxia (9.3%), physical assault/peer violence (7.7%), and suicide or self-harm attempts (7.3%). The most common cause of poisoning in childhood was medicine intake (58.2%), with paracetamol/ibuprofen being the most frequently reported agents (16.4%). The primary contributing factor to the high rate of drug-related poisonings is the storage of medications within easy reach of children in the home environment. In cases of suicide attempts and self-harm, medicine intake was the method in 70.0% of instances, with 83.7% of these cases involving female adolescents. The increased incidence of intentional drug intake during adolescence highlights not only the burden of unmet mental health needs and psychiatric conditions, but also the ease of access to medications in domestic settings. Furthermore, psychiatric disorders constituted the most frequently reported category of chronic illness among the cases (50.4%). This finding underscores the critical importance of psychiatric assessment and the provision of psychosocial support, particularly for children at risk of self-harm and suicide. The second most common cause of poisoning was household cleaning and disinfectant products (17.5%). Preventive measures include storing such items out of children's reach, in locked cabinets, and in child-resistant packaging. Scald injuries due to hot liquids were the predominant cause of burns, further reflecting the importance of household safety measures. In asphyxia cases, food aspiration was most common (67.4%), with nuts (hazelnuts, peanuts, walnuts, etc.) accounting for 54.6% of aspirated foods. Falls represented the second most frequent reason for emergency department visits, consistent with previous studies showing that domestic falls are the most common type of childhood accidents. The most commonly injured body region was the head and neck (31.1%), while the most frequent injury type was lacerations/incised wounds (20.7%), followed by soft tissue injuries (19.0%) and fractures/dislocations (18.2%). Among the 401 recorded fractures, 23.7% involved the cranial region. Analysis of the relationship between sex and incident type revealed that penetrating injuries (80.9%), firearm injuries (87.0%), traffic accidents (83.3%), and assault/peer violence (81.9%) predominantly occurred in male children. The higher incidence of stab/cutting injuries, non-motorized traffic accidents, and assault/peer violence among male patients, with this difference found to be statistically significant, represents a noteworthy finding. A total of 19 pediatric cases resulting in death were identified during the study period. The most common cause of death was asphyxia, accounting for 36.8% of cases. Among these, drowning was reported in four cases, food aspiration in two, and suffocation in one. Falls were the second most frequent cause of death (21.1%), with victims having fallen from various heights. The proportion of cases brought to the emergency department in cardiac arrest and who underwent cardiopulmonary resuscitation was also 21.1%. In addition, individual cases resulting in death included suicide by firearm injury and medicine intake (10.5%), one case of flame burn (5.3%), and one case of blunt force trauma inflicted by a peer (5.3%). A life-threatening condition was identified in 20.0% of cases, with a significantly higher proportion observed in males (21.8%) compared to females (17.9%). The highest rates of life-threatening presentations were associated with electrical injuries (81.8%) and asphyxia cases (52.1%). The statistically significant association between life-threatening status and presentations involving asphyxia or electrical injuries represents a critical finding, underscoring the severity and clinical urgency of these types of incidents in the pediatric population. Overall, 59.6% of injuries were treatable with simple medical intervention. However, severe injuries not manageable with simple medical intervention were significantly more common in high-energy traumas such as firearm injuries, electrical accidents, sharp object wounds, and falls from height. Based on treatment outcomes, 58.1% of cases were discharged directly from the emergency department, while 34.6% required hospital admission. The mortality rate was recorded as 0.7%. The most frequently utilized inpatient unit was the Pediatric Surgery ward, accounting for 43.8% of admissions. Although the majority of cases were managed on an outpatient basis—indicating that most traumas were of mild severity—the presence of life-threatening conditions in 20% of cases highlights the necessity and importance of mandatory medico-legal reporting. The findings of this study indicate that the majority of pediatric medico-legal cases presenting to Akdeniz University Hospital involved male children, predominantly of school age or in adolescence. This pattern aligns with existing literature and is often attributed to a higher propensity for risk-taking behaviours and greater involvement in outdoor activities among boys. The concentration of sharp object injuries and physical assault cases among adolescent males further underscores the role of environmental and social factors. These data highlight the non-negligible contribution of peer violence and bullying to the overall burden of pediatric forensic cases. In contrast, suicide attempts were more common among female adolescents, consistent with prior reports. In most of these cases, medicine intake was the method used. Although the proportion of firearm-related injuries was low, such cases were associated with high mortality and a significant risk of permanent disability. The seasonal increase in injuries during the spring and summer months was associated with more frequent outdoor activities and reduced supervision. The fact that most incidents occurred in the home environment underscores not only the need for improved child safety measures but also the critical importance of parental supervision. In conclusion, the majority of medico-legal cases in individuals under the age of 18 result from preventable causes. Key strategies to reduce the incidence of such cases include enhancing child safety, educating parents, implementing home and environmental modifications, raising awareness among high-risk age groups, assessing and addressing mental health needs, and ensuring the early detection of abuse and neglect. A multidisciplinary approach is essential to effectively reduce the frequency and impact of childhood medico-legal events.