Acil servislerde düzenlenen adli raporlarýn deðerlendirilmesi ve Adli Týp Kurumunca verilen raporlarla karþýlaþtýrýlmasý

AMAÇ: Bu çalýþmada, vücut dokunulmazlýðýna karþý iþlenen suçlar kapsamýnda acil hekimlerince düzenlenen adli raporlar ile ayný adli olgular için Adli Týp Kurumu Ýkinci Adli Týp Ýhtisas Kurulu’nca düzenlenen raporlarý karþýlaþtýrarak, acil hekimlerinin düzenledikleri adli raporlardaki eksiklikleri belirlemeyi ve bu raporlarda sýk yapýlan hatalarýn tespit edilmesini amaçladýk.
GEREÇ VE YÖNTEM: 01.02.2019–01.05.2019 tarihleri arasýnda Adli Týp Kurumu Adli Týp Ýkinci Ýhtisas Kurulu’na çeþitli nedenlerle gönderilen ve acil hekimlerince düzenlenmiþ 241 olguya ait adli raporlardaki standart adli raporda bulunmasý gereken bilgilerinin varlýðý (adý, soyadý, adres, olay tarihi v.b) geriye dönük incelendi. Ayrýca bu raporlarda belirtilen adli olaya neden olan travmanýn yaþamsal tehlike gösterip göstermediði ve basit týbbi müdahale ile giderilebilme durumlarý ayný olaylar için Adli Týp Kurumu Adli Týp Ýkinci Ýhtisas Kurulu’nca düzenlenen raporlarla karþýlaþtýrýlarak yapýlan hatalar tespit edildi.
BULGULAR: Çalýþmamýzda, acil servislerde düzenlenen adli raporlarýn %95.5’inde adres, %63.9’unda muayene saati, %75.9’unda olay tarihi belirtilmemiþti. Elle yazýlan adli raporlarýn %23.2’si okunaklý bulunmadý. Adli Týp Kurumu ve acil hekimlerinin ayný adli olaylar için düzenledikleri raporlarýn yaþamsal tehlike ve basit týbbi müdahale ile giderilebilme durumlarý karþýlaþtýrýldýðýnda, acil hekimlerinin adli olaya neden olan travmanýn yaþamsal tehlike ve basit týbbi müdahale ile giderilebilme durumlarýný tespit etmede yetersiz olduklarý gösterildi. Üçüncü basamak hastanelerde (eðitim ve araþtýrma hastanesi ile üniversite hastaneleri) düzenlenen adli raporlarýn, birinci ve ikinci basamak hastanelerde düzenlenen adli raporlara göre adli olaya neden olan travmanýn yaþamsal tehlike ve basit týbbi müdahale ile giderilebilme durumlarýný daha doðru tespit ettiði görüldü.
TARTIÞMA: Acil servislerde çalýþan hekimlerin pratisyen ya da acil uzmaný olmalarý fark etmeksizin, adli rapor düzenlenmesi ile ilgili hassasiyetlerinin ve bilgi düzeylerinin yetersiz olduðu tespit edilmiþtir. Acil týp ve adli týp uzmanlýk alanlarýnýn içinde yer aldýðý koordineli planlanan multidisipliner eðitimlerin arttýrýlmasýyla hatalý düzenlenen adli raporlarýn azalacaðý ve hekimlerin düzenledikleri adli raporlarýn sonuçlarý hususunda farkýndalýklarýnýn artacaðý düþüncesindeyiz.

Evaluation of forensic reports issued in emergency departments and comparison with reports issued by the Council of Forensic Medicine

BACKGROUND: Identify the deficiencies in the forensic reports prepared by the emergency physicians and to identify the frequent mistakes in these reports by comparing the forensic reports issued by the emergency physicians in the context of offences against physical integrity and the forensic reports issued by the Second Forensic Medicine Specialization Board for the same forensic cases.
METHODS: Existence of the information that should be included in the standard forensic report (name, surname, address, event date, etc.) of 241 cases prepared by emergency physicians who were sent to the Forensic Medicine Second Forensic Medicine Second Specialization Board due to various reasons between February 1, 2019, and May 1, 2019, were reviewed retrospectively. Besides, whether the trauma causing the forensic event stated in these reports is life threatening or not and whether it can be eliminated with simple medical intervention or not were compared with the reports prepared by the Council of Forensic Medicine Forensic Medicine Second Specialization Board for the same events and certain mistakes were determined.
RESULTS: Address, examination time, and incident date were not specified in forensic reports issued by emergency physicians with a ratio of 95.5%, 63.9%, and 75.9%, respectively. About 23.2% of forensic reports written by hand were not legible. When the reports prepared by the Council of Forensic Medicine and the emergency physicians for the same forensic events were compared in terms of the presence of life threat and treatment with simple medical intervention, it was shown that the emergency physicians were insufficient in determining the life hazard and the simple medical intervention to resolve the trauma causing the forensic event. It was found that the forensic reports issued in tertiary hospitals (education and research hospitals and university hospitals) were more accurate in determining the life hazard and treatment with simple medical intervention status of trauma which caused the forensic event when compared with forensic reports which were issued in primary and secondary line hospitals.
CONCLUSION: Regardless of whether the physicians working in the emergency departments are general practitioners or emergency specialists, their sensitivity and knowledge level regarding the preparation of a forensic report was found to be insufficient. We believe that with the increase of coordinated planned multidisciplinary trainings that include emergency medicine and forensic medicine, the forensic reports that are arranged incorrectly will decrease and the awareness of physicians about the results of forensic reports will increase.