Comparison of the initial forensic report and the final forensic reports of forensic cases applying to the emergency department

Introduction: Forensic cases are frequently encountered in emergency departments, which constitute the first step of forensic examination. The physician working in the emergency department is responsible for the examination, diagnosis and treatment of forensic cases, as well as detailed examination, preparation of forensic reports and notification to the judicial authorities within the scope of Article 280 of the Turkish Penal Code. In this study, we have aimed to identify and discuss the errors and deficiencies in the preparation of forensic reports, which often cause distress and anxiety for physicians, to emphasize the responsibilities of physicians in this regard and to make suggestions on the subject. Method: A total of 1556 forensic cases, who applied to Cukurova University Faculty of Medicine Department of Emergency Medicine between May 2019 and May 2022, received a temporary forensic report, and then an official forensic report was prepared at the Department of Forensic Medicine, were included in this study. The cases included traffic accidents, work accidents and other forensic cases (all forensic cases except work accidents and traffic accidents). Patients with a temporary report but no official report and poisoning cases were excluded from the study due to the lack of an opposing party and the low rate of obtaining a official report. The patients of the study between May 2019 and May 2021 were scanned retrospectively. In order to examine the impact of the pandemic on forensic cases in more detail, patients with admission dates between May 2021 and May 2022 were examined prospectively. For this purpose, patients were divided into three groups according to the application dates to the emergency department in which temporary forensic reports were prepared: Group 1, those who applied between May 2019-May 2020, Group 2, those who applied between May 2020-May 2021, and Group 3, those who applied between May 2021-May 2022. Discordances between the temporary forensic reports given by the Department of Emergency Medicine and the official reports given by the Department of Forensic Medicine were investigated in terms of the assessment of life-threatening situations and whether the injury could be resolved with simple medical intervention. Results: Between May 1, 2019 and May 1, 2022, the period in which our study was conducted, a total of 216,111 emergency cases over the age of 18 were admitted to our emergency department. 5.3% (n=11487) of the admitted cases were forensic cases. An official report was written in forensic medicine for 13% of forensic cases (n=1596). It was observed that 5% of work accidents, 15% of traffic accidents, and 14% of other forensic cases were referred to forensic medicine for an official report after temporary reports were written. 449 traffic accidents, 56 work accidents and 1051 other forensic cases were included in the study, after applying to emergency medicine department and getting a temporary report, and then applying to forensic medicine department and getting an official report. There were a total of 1556 forensic cases in our study, and these cases constituted 0.007% of all cases applying to emergency department. Of the 1556 patients included in the study, 71% (n = 1104) were male and 29% were female (n = 452). The mean age was 35.59±13.56. When official reports and temporary reports were compared, there was a discordance in 14.5% of the reports in terms of whether the injuries could be resolved with simple medical intervention and in 10.7% in terms of life-threatening situation assessments. And also when evaluated by years; in terms of simple medical intervention evaluation (p = 0.014) and life-threatening situations (p < 0.001), it was observed that the discordance rates tended to increase statistically. Conclusion: When the provisional forensic reports written by Emergency Physicians in emergency departments are compared with the final forensic reports written later by Forensic Medicine physicians, incompatibilities are observed, especially in the fields of BTM and vital risk assessment, and it is observed that forensic reports are faster and more accurate, both because of the decrease in physician responsibility and because they have an important place in the establishment of justice. In order to be prepared properly, it is important for the emergency medicine physicians who prepare these reports to receive detailed training, especially on remediability with BTM and vital risk assessment, and to provide 24/7 access to Forensic Medicine Specialists in emergency departments, both in terms of the functioning of the judicial judiciary and the rights of physicians and patients. Keywords: Forensic case, temporary forensic report, official forensic report.