Background.
The study relevance is substantiated by the growing numbers of road vehicles and cervical spine traumas occurring among all spinal injuries. Currently, there is no common vision of the ...cervical trauma pathogenesis, diagnostic algorithm or treatment, which stipulates difficulties in the forensic evaluation of soft tissue injuries of the neck, especially combined with the head or spine traumas around neck, as well as certain diseases.
Objectives.
A study of the incidence of cervical spine distortion injuries and their clinical and forensic assessment for severity to human health.
Methods.
A retrospective selective single-stage trial and analysis of 32 forensic medical reports on road accident and physical injury administrative cases in 2017 (single year) have been conducted. Normally distributed data are presented as mean (M), standard deviation (SD) and percent shares. The significance of inter-share variation was estimated with Student’s t-test.
Results.
Cervical spine distortion injuries more frequently associated with traumas to drivers than passengers inside the salon (81.2%), especially in passenger vehicles, with front-seat travellers inflicted most often (60.0%). Cases of independent pathology were very rare. The most common were combinations with soft tissue injuries, combined blunt trauma to the head, torso and limbs, with craniocerebral or maxillofacial trauma. Cervical osteochondrosis was revealed in 18% cases. Primary diagnosis predominantly grounded on complaints and history (67%), with only 12% cases using a comprehensive neurological examination or instrumental methods. The severity was assessed in the context of concomitant injuries. Acute and moderate severity had equal rates of 6.2%, light severity — 37.5%, no damage — 9.3%. Non-qualified remained 39.8% cases due to a lack of full clinical and instrumental examination (66.7%) or the victim’s failure to appear (13.3%); 20% cases were expert-reported as uncertain for trauma circumstances and mechanism.
Conclusion.
Further research and systematisation of the data accumulated are necessary. The following clinical and forensic evaluation, as well as statistical analyses will facilitate common diagnostic and severity assessment algorithms to develop for mechanical soft tissue and ligament injuries of the cervical spine.
Aim.
The paper analyses the dynamics and structure of forensic medical examinations conducted by an expert panel in cases involving medical malpractice in the Krasnodar Krai (2010– 2018).
Materials ...and methods.
The authors studied the annual reports along with the archived copies of expert panel reports on the cases of medical malpractice submitted in 2010–2018 by the Department for Complex and Expert Panel Examinations (Bureau for Forensic Medical Examination, Krasnodar). The obtained results were processed using Microsoft Excel 2010 and SPSS Statistics Data Editor v.17.0. In this study, the authors employed the following methods: retrospective, comparative and analytical.
Results.
In 2010–2018, a total of 1,023 expert panel examinations were conducted in cases involving medical malpractice. A steady increase in the number of examinations (from 36 in 2010 to 245 in 2018) is associated with the growing number of citizens complaining about the poor quality of medical care, the interest of judicial and investigation authorities in looking into such offences, etc. A direct cause-and-effect relationship between imperfect and erroneous healthcare delivery and ensuing adverse effects was established in 212 cases, whereas indirect or no relationship was determined in 130 and 644 cases, respectively. The number of examinations pertaining to criminal cases amounted to 29.1%, showing an increase by 3.5 times (from 16 in 2010 to 57 in 2018); while the number of examinations related to civil cases and those conducted during pre-investigation checks came to 18.2% and 52.7%, respectively.
Conclusion.
The study shows a steady increase in the number of examinations related to medical malpractice (including criminal cases), which reveal a direct cause-and-effect relationship between errors in healthcare delivery and clinical outcomes
Aim. To examine cases of diagnose setting for cerebral commotion after road accidents within Krasnodar city, to justify the diagnose, to analyze the level of harm committed.Materials and methods. A ...retrospect analysis has been done to 353 expert reports and forensic medical examination acts issued after road accidents which involved medically documented cerebral commotion. Analyzed cases have been detected by continuous sampling. Conditions taken into consideration: sex, age, circumstances, time, type of accident and type of involvement for injured people, localization and type of injury, reasons for cerebral commotion rejection from experts diagnose.Results. As a result, 199 cases have missed cerebral commotion as experts diagnose – 63.3% of these cases missed data for dynamic neurological examination of the person aggrieved, 30.7% of cases didn’t contain objective evidence of cerebral commotion, in 3.5% of cases medical outpatient card was not provided for examination by the investigator, in 2.5% of cases cerebral commotion diagnose was cancelled by clinicians after dynamic patient follow-up. In 39% of cases cerebral commotion was diagnosed in pedestrians, in 20% of cases in car drivers, in 19% of cases car passengers were injured. In nine cases (6%) there was an accident involving motorcyclists and cyclists, 4 (3%) cases were passengers of public transport. 77% of the injured people received medical care in a hospital, 23% – on an outpatient basis. In 78% of cases with cerebral commotion there were injuries of soft tissues of the head, fractures of the skull bones were revealed in 14%. Light damage to health on the grounds of a short-term disorder is established in 45% of cases, harm to health of average severity – in 20%, serious harm – in 31%, harm to health was not determined in 4%.Conclusion. The obtained results indicate that the diagnosis of cerebral commotion is established based on anamnesis and complaints, it doesn't reflect the objective symptoms of concussion. Dynamic monitoring of the course of craniocerebral trauma is not ensured, necessary laboratory and instrumental diagnostics are not carried out. It leads to the impossibility of taking this diagnosis into account when conducting forensic medical examination because of its unreasonableness.
Studied materials of non-fatal road traffic injuries in children by the nature of damage, time, location and circumstances of their occurrence; analyzed forensic evaluation caused by gravity harm to ...health.
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