Is post-traumatic stress disorder related to the severity of physical trauma?

OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS: It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION: Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.

Is post-traumatic stress disorder related to the severity of physical trauma?

SUMMARY OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS: It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION: Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.

Drowning in submerged cars caused by traffic accidents.

BACKGROUND: Traffic accidents are among the most common causes of death. A small proportion of drownings are associated with traffic accidents. The roads in the Eastern Black Sea Region, where the study was conducted are fairly close to the seas, rivers, and ponds. This study aims to evaluate the cases who underwent autopsies after the traffic accident between 2009 and 2016 and who were found to have died as a result of drowning. METHODS: A retrospective examination was made of the autopsy reports in the period 2009-2016. RESULTS: As a result of the examination of forensic reports, from a total of 7124 autopsies performed in our center between 2009 and 2016, 41 (0.57%) were seen to be due to death in a traffic accident that resulted in drowning. Of the vehicles involved in the ac-cidents, 30 (73.2%) were retrieved from a river/stream, 7 (17.1%) from a lake, and 4 (9.7%) from the sea. In all 39 cases, the primary cause of death was determined as asphyxia related to drowning. Other reasons affecting death were traumatic intracranial bleeding in 7 (17.1%) cases, medulla spinalis injury in 4 (9.7%), and pulmonary injury in 2 (4.9%). CONCLUSION: It was determined in the study that the typical autopsy results of trauma and drowning after a traffic accident could coexist. Drowning alone could be the cause of death, even though there was a traumatic origin such as a traffic accident in such cases. It was revealed that chemical and microscopic examinations should be handled together with crime scene results and eyewitness statements in addition to traumatic results during the examination phase.

Deaths due to 'patpat' accidents in the Black Sea Region, Turkey.

BACKGROUND: Overtime, agricultural machines have been designed appropriate to more simple needs, instead of tractors which have a wide area of use. An example of these is the 'patpat,' so named because of the sound of the motor, and for which the main purpose is ploughing. METHODS: A patpat is a single-axle, two-wheeled tractor with a trailer attached. In this descriptive study, the descriptive characteristics and causes of death were analyzed of case related to patpat accidents for which autopsies were performed by the Forensic Medicine Institution Trabzon Group Directorate between 2006 and 2017. RESULTS: Information was retrieved from the scene of accident examination documents, and the autopsy and laboratory records. The 21 cases comprised 17 (81%) males and 4 (19%) females, with a mean age of 47.6±20.3 years (median: 57, range: 10-75 years). Of the total accidents, in 85.7% (n=18), no other vehicle was involved. Following the accident, 52.4% (n=11) of the patpats were found at the side of the road, and 33.3% (n=7) at the edge of a stream or at the bottom of a steep valley. The cause of the accident was determined to be that the patpat had overturned on a bend in 33.3% (n=7) cases and in 85.7% (n=18) of cases, the patpat was found overturned or on its side. The most common injury was being thrown from the vehicle (38.1%, n=8), and in 66.7% (n=14) of cases, the deceased was the patpat driver. CONCLUSION: Patpat accidents are a serious problem because of the frequency of use of these vehicles without proper supervision and especially because of the hazardous topographical conditions where they are used.

Evaluation of the fire-related deaths: Autopsy study.

BACKGROUND: The fire is a public health problem that occurs because of various reasons, threatens the lives of organisms, and may cause economic losses. The forensic investigation and the crime (event) scene investigation and first medical examination to be performed for the persons in the fire scene might reveal important evidences. METHODS: The autopsy reports prepared in Trabzon Branch Office, The Ministry of Justice Council of Forensic Medicine, for the death cases found in fire scene between 2007 and 2016 were retrospectively examined. RESULTS: As a result of analyzing the 10-year archive data, it was determined that 100 (63.3%) of 158 cases, which have been found in the fire scene and undergone forensic autopsy, were male and 58 (36.7%) were female. By excluding the group of cases with undetected origin, it was determined that there was a statistically significant difference between the homicide-caused deaths and the deaths with other causes (accident and suicide) in terms of the carboxyhemoglobin (HbCO) levels. By grouping the fire scene as outdoor and indoor areas, the comparison made between the HbCO levels of cases is presented in table. The difference between the two groups was found to be statistically significant (p<0.05). CONCLUSION: Starting from the crime scene investigation, a detailed radiological, toxicological, and pathological investigation must be performed for the persons taken out from the fire scenes. It was observed that the HbCO levels can be used in determining the space in which death occurred, the origin, and the comorbidities of the individual.

Medicolegal evaluation of cases with burn trauma: Accident or physical abuse.

INTRODUCTION AND OBJECTIVE: Burns are thermal injuries that may have a wide variety of clinical consequences from simple injuries to mortality. There are many aspects that must be medicolegally addressed in both non-survivors and survivors from burn injuries. The objective of this study was to determine sociodemographic characteristics, injury patterns, treatment requirements and prognoses of patients with burn injuries to evaluate the findings of neglect-abuse and forensic reporting processes. This study also aimed to contribute to the medicolegal classification criteria in respect of the factors that have an effect on the prognosis in the analyses. MATERIAL AND METHOD: The study was conducted by retrospective review of digital files and paper records of patients who received therapy in the Burns Unit of KTU Farabi Hospital between 1st January, 2013, and 31st December, 2017. RESULTS: Evaluation was made of a total of 1225 patients, comprising 769 (62.8%) males and 456 (37.2%) females, with a mean age of 21.8 ± 23.8 years (range, 1-89 years). The mean burnt body surface area was 14.29 ± 13.74. A trauma-related psychiatric disorder was diagnosed in 60 (4.9%) patients during treatment. When the medical history and physical examination findings were evaluated together, burn injuries suggested physical abuse in 54 patients (4.4%). The doctors who evaluated the patients with burn injuries in the emergency room and those who applied treatment in the Burns Unit made a forensic notification for 379 (30.9%) patients. The mean age of non-survivors was significantly higher than that of patients who survived to discharge (56.54 ± 28.60 years for non-survivors and 19.39 ± 23.12 years for survivors; p < 0.001). CONCLUSION: Burn injuries are frequently encountered, and they require precautionary measures. Burn injuries due to abuse are more frequently observed in the elderly and especially in children. Thus, the findings must be correctly interpreted, and more effort should be made to improve the knowledge of healthcare professionals about forensic reporting. Moreover, regulations should be implemented in respect of the medicolegal classification of trauma.

Evaluation of geriatric suicides in Turkey.

INTRODUCTION: Suicide is defined as an individual taking action towards themselves with the intention of terminating their own life. According to the World Health Organisation (WHO), 800,000 deaths per year worldwide are due to suicide. In 2012, suicide cases constituted 1.4% of all the deaths worldwide. In most countries throughout the world, the suicide rates of the elderly are higher than those of other age groups. Epidemiological studies have concluded that suicide rates increase with advancing age in all societies, this increase accelerates after the age of 65 years and the highest rates are reached after the age of 75 years. The aim of this study was to evaluate the demographic features, suicide methods and reasons for suicide in geriatric suicide cases between 2009 and 2013 using the data of the Turkish Statistics Institute (TUIK). MATERIAL AND METHODS: A retrospective evaluation was made of the TUIK data related to proven suicide cases aged 65 years and older in the 5-year period of 2009-2013. RESULTS: A total of 1723 geriatric suicides were determined in Turkey between 2009 and 2013. These comprised 1284 (74.5%) males and 439 (25.5%) females, showing a rate of males approximately 3 times higher than that of females. An increase of approximately 10% was seen in the deaths by suicide in 2013 compared to 2009. The highest rate of geriatric suicides within total geriatric deaths was observed to be in 2012 (15.2%) and the lowest rate was in 2010 (12.4%). The most common method of suicide in both genders was hanging. In the majority of cases of geriatric suicide of both genders, the reason could not be determined. In those cases where the reason was known, the most common reason was illness. CONCLUSION: It has been reported that the most significant factors in suicide prevention are friends and family. As there continues to be an extensive family structure and family connections are strong in Turkey, this can be considered to be one of the reasons for lower rates of geriatric suicide compared to other countries. As there is a strong adherence to Islam in Turkey, another significant reason for the low rate could be the effect of the belief that suicide is a sin in the Islamic religion.