Are There Any Differences in Road Traffic Injury Outcomes between Older and Younger Adults? Setting the Grounds for Posttraumatic Senior Personal Injury Assessment Guidelines.

Injury outcomes seem to be more severe in older than younger persons. This may make personal injury assessment (PIA) particularly difficult, mainly because of seniors' previous health frailties. To set the grounds for seniors' PIA guidelines, we compared an older with a younger adult population of trauma victims and, secondarily, identified differences between the groups regarding three-dimensional and medico-legal damage parameters assessment. Using a retrospective study of victims of road traffic accidents, we compared the groups (n = 239 each), assuring similar acute injury severity (ISS standardised difference = 0.01): G1 (older adults); G2 (younger adults). Logistic regression was used to estimate the odds ratio. G1 revealed higher negative consequences when considering the three-dimensional damage assessment, with more frequent and severe outcomes, being a cause of further difficulties in daily living activities, with a loss of independence and autonomy. Nevertheless, regarding the medico-legal damage parameters, permanent functional disability did not show significant differences. This study generates evidence that reveals the need to rethink the traditional methodology of PIA in older persons, giving more relevance to the real-life contexts of each person. It is essential to: obtain complete information about previous physiologic and health states, begin the medico-legal assessment as early as possible, make regular follow-ups, and perform a multidisciplinary evaluation.

Children's outcomes in road traffic accidents: challenges for personal injury assessment.

Children represent a specific group of road traffic accident (RTA) victims. Performing a personal injury assessment (PIA) on a child presents a significant challenge, especially when assessing permanent disabilities and needs. However, medico-legal recommendations for PIA in such cases are lacking. The main objective of this study was to analyse the differences between children and a young- and middle-aged adult population of RTA victims to contribute to the development of relevant guidelines. Secondary objectives were to identify and characterize specifics of children's posttraumatic damages regarding: (i) temporary and permanent outcomes; and (ii) medico-legal damage parameters in the Portuguese context. We performed a retrospective study of RTA victims by comparing two groups (n = 114 each) matched for acute injury severity (SD = 0.01): G1 (children) and G2 (young- and middle-aged adults). Logistic regression was used to estimate the odds ratios. G1 presented a greater chance of evolving without or with less severe body, functional and situational outcomes (three-dimensional assessment methodology), and with lower permanent functional disability values than G2. Our findings suggest that childhood trauma generally has a better prognosis than trauma in young- and middle-aged adults. This study generated evidence on the subject and highlighted the most significant difficulties encountered by medico-legal experts when performing PIA in children. Key points: This retrospective study of PIA in child victims of RTA in Portugal considered outcomes in victims' real-life situations.Several significant differences between children and young- and middle-aged adults were observed.Children's cases presented better results in terms of the severity of body, functional and situational outcomes, and permanent damage parameters.The average time between the RTA and final PIA date and the consolidation time were longer for children because of the need to wait for the Children's next growth phase or final pubertal period (as applicable), which increased the time for PIA conclusion.There were several difficulties in the medical-legal evaluation of children's cases, which was a complex process because the trauma affected them in their growth phase.

Non-accidental head injury of infants: legal implications for the pediatric neurosurgeon.

BACKGROUND: Though the neurosurgeon's role in non-accidental head injury (NAHT) is the prompt recognition and care of the inflicted injuries, he/she should be aware of the possible legal implications related to this particular neurosurgical condition. MATERIAL AND METHODS: Based on published data and their own clinical and medico-legal practice, the authors review the role of the neurosurgeon in NHAT. RESULTS: Besides the contribution that can be given by the neurosurgeon to a correct differential diagnosis, he/she is likely to be involved in the interpretations of the pathological findings in the case where the judge may request for a medical opinion concerning etiology, circumstances, severity, and consequences. As a member of a multidisciplinary team, usually the neurosurgeon is only requested for information regarding the lesions he was called to recognize and treat. Nevertheless, such information may have a pivotal part in the evaluation process. Consequently, the neurosurgeon should be able to reach a correct differential diagnosis of NAHT among all the events that may share similar clinical and anatomo-pathological characteristics and be aware of the ongoing scientific controversies related to the diagnosis and pathophysiology. CONCLUSIONS: In practical terms, the pediatric neurosurgeon is called to individuate and record all the precise details of the condition to be eventually offered to the judge in case of controversy. Whereas the diagnosis of NAHT should be evoked at the initial phase in order not to leave the child unprotected, all possible alternative hypotheses should be ruled out "beyond reasonable doubt" for the court. The medical file should be maintained in the record carefully and be accessible even after a long time.

Health and Economic Impact of Atrial Fibrillation of Workers in Italy: Social Security Benefits.

BACKGROUND: The aim of this research was to analyze trends in social security applications in Italy as a result of the onset of atrial fibrillation, analyzing data pertaining to the classification of professions and assessing the economic impact on the social security system. METHODS: We analyzed all applications for invalidity allowances and invalidity pensions throughout Italy over a 10-year period from 01.01.2009 to 31.12.2019, giving specific attention to all reports indicating atrial fibrillation as the principal diagnosis (Cod. ICD-9-CM 427.31). We then extracted the relative expenditure data for said benefits. The results of all analyses have been collated in tables. RESULTS: Over the period in question, a total of 3468 applications for assistance were filed throughout Italy indicating a diagnosis of atrial fibrillation, of which 58% were rejected, 41% qualified for an invalidity allowance, and only 1.1% qualified for a pension. On average, every year, 1100 workers received social security benefits as a result of a diagnosis of atrial fibrillation, which equates to an average annual expenditure of EUR 10 million. A comparison of the data from the first observation year (2009) with data from the last (2019) shows a rising trend in the number of beneficiaries and consequently in expenses. CONCLUSIONS: The social security assistance provided by the Italian government by means of the National Institute of Social Security is fundamental to social cohesion and to those who are either permanently disabled from working or those with a significantly diminished earning capacity. This assistance is associated with a significant financial cost, which requires careful monitoring.

Métodos para Valoración del Perjuicio Estético Causado Por Cicatrices Faciales

RESUMEN: Dentro del daño estético, las cicatrices son las secuelas más frecuentes. Al momento de su valoración médicolegal, hay que considerar las distintas formas en que se pueden presentar, además de su visibilidad a distancia. El objetivo de esta revisión es conocer los distintos métodos existentes usados para la valoración del perjuicio estético causado por cicatrices faciales. Se realizó una búsqueda bibliográfica en PubMed y Scielo, obteniéndose cuatro artículos atingentes al tema. Llama la atención la escasez de métodos estandarizados para su valoración, advirtiendo, además, que los pocos baremos existentes son para valorar el daño en el ámbito civil o laboral. Para estandarizar los criterios clínicos y medicolega les es recomendable el uso de métodos cuantitativos. Finalmente, al momento de evaluar las secuelas de las lesiones, es importante considerar no sólo el compromiso estético y funcional, sino también las implicancias biopsicosociales en la vida del individuo.

ABSTRACT: In relating to facial aesthetic damage, scars are the most frequently observed. When these scars are assessed for medico-legal purpose, it is necessary to consider the different ways in which they can be presented, and their visibility from distance. This review has as objective to evaluate the different existing methods used for the assessment of cosmetic damage caused by facial scars. The bibliographic search was carried out in PubMed and Scielo, where four articles related to the topic were found. The shortage of standardized methods for their assessment is striking, in addition, draws attention that the few existing scales are used to assess the damage in civil and labour affairs. To standardize clinical and medico-legal criteria, the use of quantitative methods is recommended. Finally, to evaluate the result of the injuries, it is important to consider not only the aesthetic and functional consequences, but also the biopsychosocial implications in the life of an individual.

Discrepancies of asbestos body and fiber content between formalin-fixed and corresponding paraffin embedded lung tissue.

BACKGROUND: Formalin-fixed lung tissue and paraffin blocks containing peripheral lung tissue obtained from subjects with an occupational asbestos exposure are both regarded to be suitable to determine asbestos load. Because sample preparation of paraffin blocks requires a more intense treatment than formalin-fixed tissue, we tested whether asbestos analysis of formalin-fixed lung tissue and paraffin blocks obtained from the same patients deliver comparable results. MATERIALS AND METHODS: We determined numbers of asbestos bodies (AB) and amphibole asbestos fibers (AF) in formalin-fixed lung tissue and corresponding paraffin blocks from 36 patients. For AB counts, samples were digested in sodium hypochlorite. For AF analysis, tissue was freeze-dried and then ashed. Results were reported as numbers of AB and AF per gram dry lung tissue. RESULTS: Both AB counts as well as AF counts were lower in paraffin blocks than formalin-fixed lung tissue. Compared to formalin-fixed tissue, the limit of detection was higher for paraffin blocks, rendering more results from paraffin blocks not interpretable than from formalin-fixed tissue (8 samples versus 1 for AB and 15 samples versus 4 for AF). DISCUSSION AND CONCLUSION: Asbestos analysis of paraffin blocks may lead to underestimation of asbestos exposure. This should be considered when assessing occupational asbestos exposure through lung dust analysis in medico-legal evaluation.

Proposal for the Application of a Quality Indicator to Medico-legal Consultations in the Field of Medical Liability.

INTRODUCTION: In recent decades, the number of professional liability disputes has increased, especially in the civil sector. In these liability assessments, medico-legal experts have become the linchpin. Law No. 24/2017, concerning professional liability in Italy, requires that guidelines and best practices be established to identify the necessary elements for writing expert reports in the legal sector. MATERIALS AND METHODS: The authors have created a numerical indicator to be applied to 150 legal expert reports on professional liability, enabling them to evaluate the methodological quality of those reports. The results are then compared with the outcome of the legal proceedings in order to establish the suitability of this quality index for evaluating the work of medico-legal experts. RESULTS: Of the 150 reports considered, 14 were scored inadequate, 75 adequate and 31 good. These inadequate (according to the indicator) reports presented a higher probability of being scored inadequate in court proceedings, compared to the risk of inadequacy of all the reports; OR 4.6 (95% CI 1.25-16.90). This probability significantly increased on comparing the inadequate reports with the adequate; OR 5.6 (95% CI 1.28-24.41), and the inadequate with the good; OR 7.73 (95% CI 1.50- 39.87). DISCUSSION: Application of the proposed indicator is simple and produces a high-quality result, thus ensuring an accurate and tenable appraisal of methodological quality. CONCLUSION: The indicator proposed serves as a useful starting point for creating the necessary methodological standards for medico-legal experts in the field of professional liability as recommended by Law No. 24/2017.

When a virus (Covid-19) attacks human rights: The situation of asylum seekers in the medico-legal setting.

The Covid-19 pandemic is a global health emergency that requires immediate, effective action by governments to protect the health and basic human rights of everyone's life. Refugees and migrants are potentially at increased risk because they typically live in overcrowded conditions often without access to basic sanitation. Since the beginning of the official lockdown for Covid-19, the medico-legal assessment of physical violence related to obtaining status or other forms of human protection has been frozen.

Take-Home Messages from the COVID-19 Pandemic: Strengths and Pitfalls of the Italian National Health Service from a Medico-Legal Point of View.

The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 of which occurred in Italy. In Italy, the demand for intensive care over the course of this pandemic crisis has been exceptionally high, resulting in a severe imbalance between the demand for and availability of the necessary resources. This paper focuses on elements of preventive medicine and medical treatments in emergency and non-emergency situations which, based on the international scientific literature, may prove to be useful to physicians on a behavioral level and avert professional liability problems. In order to achieve this objective, we have performed a search on MEDLINE to find published articles related to the risks associated with the pandemic that contain useful suggestions and strategies for mitigating risks and protecting the safety of the population. The results have been collocated in line with these specific study areas.

Is the Italian consent to transfusion really informed? A medico-legal analysis between old ghosts and new evidence.

In healthcare systems of developed countries, obtaining informed consent is a necessary and fundamental requirement for the administration of any medical treatment. In Italy, for the administration of the recipient's informed consent for a blood transfusion, a pre-printed form is used in line with the Decree of the Ministry of Health dated 2 November 2015. This paper aims to analyse this form in light of the European legal provisions and following the enactment of Italian Law No. 219 of 2017 on informed consent and advance treatment directives. Our review shows that the structure of the form can be improved in light of the new direction provided by Italian law, the scientific advancement on transfusion risks, and the potential to reduce the use of blood components. Revising this form could be the opportune time to include written information on Patient Blood Management strategies. Though not exhaustive, this proposal may stimulate debate on the point and produce further contributions.

The medico-legal assessment of aesthetic damage. A correlation analysis between experts and an operative proposal.

Aesthetic damage, defined as any detrimental modification of the individual morpho-functional exterior attributes, is difficult to assess, since the perception of its entity is rather subjective. This study aims to provide a medico-legal contribution to the assessment of this kind of damage. 60 photographic images, representing stabilized aesthetic damage, were collected and showed to 16 expert evaluators, who were required to exclusively quantify the objective component of the aesthetic impairment. The inter-observer agreement for the assessments was calculated using the Intraclass Correlation Coefficient (ICC). Looking into specific characteristics of both the injury and the damaged subject, the assessors were more consistent in quantifying the damage in male subjects (ICC 0.68) and in subjects aged over 50 years (ICC 0.81) as well as in assessing extensive damages (ICC 0.61) than those of mild severity (ICC 0.41). The assessment of impairments located in the facial area resulted in a high level of concordance (ICC 0.73), while damages located the head and neck regions presented the lowest concordance (ICC 0.35). The evaluators were more consistent in assessing the outcomes of burns (ICC 0.70). Regardless the various reasons underlying the different degree of concordance, these results and the high degree of the overall concordance (ICC 0.63) point out the skillfulness of medicolegal professionals to formulate a complex judgment as more objectively as possible. Finally, an operative proposal was outlined to guide medico-legal professionals or interns in evaluating the aesthetic damage as more objectively as possible.

Abuso sexual en el paciente pediátrico / Sexual abuse in the pediatric patient

Resumen El abuso sexual infantil es la causa específica más común de violencia intrafamiliar en menores de 18 años en Costa Rica. Entre los factores de riesgo se encuentran el pertenecer a una familia disfuncional, el uso de la violencia como método de educación, la falta de educación sexual y los menores de edad con discapacidades cognitivas o trastornos del desarrollo. Los menores de edad tienden a ser víctimas abusadas crónicamente y que su reporte es tardío por lo que la valoración debe iniciarse desde que se tiene la mínima sospecha. El abordaje debe ser integral, realizando una detallada historia clínica y examen físico, así como una valoración legal y recolección de evidencia. Un sinnúmero de consecuencias sufren las víctima de abuso sexual infantil, entre ellos se encuentran los trastornos de personalidad, el trastorno de género, las enfermedades de transmisión sexual y la depresión. Si bien Costa Rica está a la vanguardia a nivel internacional en temas de derechos humanos, la incidencia de casos reportados de abuso sexual infantil ha incrementado en los últimos años por lo que es un tema que involucra a todos los actores de la sociedad para su abordaje.

Abstract Child sexual abuse is the most common specific cause of intrafamilial violence in children under 18 years old in Costa Rica. Among the risk factors are belonging to a dysfunctional family, the use of violence as a method of education, lack of sexual education, and children with cognitive disabilities or developmental disorders. Minors tend to be chronically abused victims and that their report is delayed, so the assessment should start from the moment of the slightest suspicion. The approach must be comprehensive, performing a detailed clinical history and physical examination, as well as a legal assessment and evidence collection. Countless consequences suffer the victims of child sexual abuse, among them are personality disorders, gender disorder, sexually transmitted diseases, and depression. Although Costa Rica is at the forefront of international human rights issues, the incidence of reported cases of child sexual abuse has increased in recent years, which is why it is an issue that involves all actors in society to address it.

The contribution of legal medicine in clinical risk management.

BACKGROUND: In advanced health services, a main objective is to promote the culture of safety and clinical risk management. In this regard, the reporting of sentinel events fits within a perspective of error analysis, attempting to propose solutions aimed at preventing a new occurrence of the harmful event. The purpose of this study is to analyze the contribution of medico-legal litigation in the management of clinical risk and to propose an organizational model so as to coordinate the intervention of clinical risk management and medico-legal services. METHODS: Retrospective review of 206 cases of medico-legal litigation, settled against a Hospital of a North-eastern city in Italy from January 1, 2014 and December 31, 2015. RESULTS: Approximately 20% of cases, that are classifiable as "sentinel events", were not reported due to various factors. The reason that these events are under-reported is mainly due to the latency between the event itself and its manifestation as a serious damage to health as well as the discomfort in reporting the events of this kind, which is still widespread among healthcare workers. The systematic research of the available documentation for medico-legal purposes permits the acquisition of more information concerning the clinical event, thereby increasing the number and accuracy of the reports to the clinical risk unit. CONCLUSION: The analysis of medico-legal litigation is a valid tool to enhance the reporting of "sentinel events". One possible proposal is the implementation of an organizational model to establish a rapid procedure for the reporting of sentinel events during the evaluation of medico-legal litigations.

Valoración del daño corporal en el trauma nasal / Body damage assessment in the nasal trauma

La nariz es la parte del tracto respiratorio superior que contiene el órgano periférico del olfato, está conformada por la nariz propiamente dicha y la cavidad nasal, que a su vez se encuentra dividida por el tabique nasal en la cavidad nasal derecha e izquierda. Entre sus funciones principales se encuentran la olfacción, la respiración, la filtración de polvo, la humidificación del aire inspirado, la recepción y eliminación de las secreciones de los senos paranasales y de los conductos nasolacrimales. Se forma a partir de la cuarta semana de desarrollo embrionario del ectodermo que forma el proceso frontonasal que a su vez se invagina dando origen a las placodas nasales de las cuales se forman las fosas nasales. La porción nerviosa de éste órgano proviene de una evaginación del neuroectodermo que forma el cerebro anterior del embrión.Los traumatismos nasales son los más frecuentes de los trauma en la cara, es la causa más frecuente de traumatismo en los accidentes de tránsito (40%), accidentes doméstico (20%), agresiones (15%), caídas casuales (14%), accidentes laborales (3%) y otras (8%). Afecta más a hombres jóvenes y en cuanto a género tiene una clara predominancia en el sexo masculino (68%). La alta tasa de lesiones por trauma nasal se debe a que esta es una protuberancia que sobresale del macizo facial y es más fácil de lesionar que el resto de la cara. En estos se pueden ver afectadas la partes blandas o el esqueleto óseo o cartilaginoso y como consecuencia pueden quedar secuelas tanto funcionales como estéticas en las personas que sufrieron este tipo de daño, de ahí la importancia, desde el punto de vista Médico Legal, de saber cómo valorar estos casos y otorgar el porcentaje justo y que merecen estos lesionados.

The nose is the part of the upper respiratory tract that contains the peripheral organ of smell, is made by said actual nose and nasal cavity, which in turn is divided by the nasal septum on the right and left nasal cavity. Its main functions are olfaction, breathing, dust filtration, humidification of the inspired air, the receipt and removal of secretions from the sinuses and the nasolacrimal ducts. It is formed from the fourth week of embryonic development ectoderm forming process frontonasal invaginates turn giving rise to the nasal placodes of which are formed nostrils.Nerve portion of this body comes from an outgrowth of neuroectoderm forming the forebrain of the embryo.Nasal injuries are the most common of the trauma to the face, it is the most common cause of injury in traffic accidents (40%), domestic accidents (20%), assault (15%), accidental falls (14%) , labor (3%) and other accidents (8%). It affects more young men and in gender has a clear predominance in males (68%). The high rate of injuries nasal trauma because this is a bump protruding from the facial skeleton and is easier to injure the rest of the face.These can be seen affected the soft tissue or bone or cartilage skeleton and as a result can be both functional sequelae and aesthetic in people who suffered this kind of damage, hence the importance, from the point of Forensic view, to know how to assess these cases and grant fair percentage and deserve these injuries.

ADAPTACIÓN DE UNA METODOLOGÍA PARA LOS PROCESOS DE ADQUISICIÓN DE SISTEMAS DE AIRE ACONDICIONADO EN SERVICIOS DE SALUD / ADAPTATION OF A METHODOLOGY FOR PROCUREMENT PROCESSES OF AIR CONDITIONING SYSTEMS IN HEALTH SERVICES / ADAPTAÇÃO DE UMA METODOLOGIA PARA OS PROCESSOS DE AQUISIÇÃO DE SISTEMAS DE AR CONDICIONADO NOS SERVIÇOS DE SAÚDE

La adquisición efectiva de tecnologías en salud está enfocada al mejoramiento de la calidad y eficiencia, en la prestación de los servicios de salud ya que es un proceso complejo. Dentro de este proceso se destacan la evaluación técnica y clínica. El objetivo de la evaluación de tecnologías en salud es recolectar, analizar y sintetizar información y conocimiento para contribuir a mejorar la toma de decisiones en la práctica médica y en las políticas de salud. En este trabajo se presenta una evaluación en procesos de adquisición de sistemas de aire acondicionado en servicios de salud, basada en la definición de variables en campos de evaluación; dichas variables cuantifican lo técnico y funcional del equipo en su entorno clínico y económico. De igual manera, se pretende impulsar en los departamentos de ingeniería clínica la implementación de metodologías de amplia aceptación y efectividad que tienen como objetivo primordial la adquisición de tecnologías en salud basados en la evidencia.

The effective acquisition of health technologies is focused on improving the quality and efficiency in the provision of health services as it is a complex process. Within this process the technical and clinical evaluation are highlighted. The objective of the health technology assessment is to collect, analyze, and synthesize information and knowledge to help improve decisionmaking in medical practice and health policy. This paper presents an evaluation process of acquiring air conditioning systems in health care facilities, based on the definition of variables into a field evaluation; these variables quantify the technical and functional team in their clinical and economic environment. Similarly, it is intended to promote in clinical engineering departments, the implementation of widely accepted methodologies and effectiveness that have, as its primary objective, the acquisition of technologies in evidence-based health.

A aquisição efetiva das tecnologias da saúde é focada na melhoria da qualidade e eficiência na prestação de serviços de saúde, pois é um processo complexo. Dentro deste processo se destaca a avaliação técnica e clínica. O objetivo da avaliação de tecnologias em saúde é coletar, analisar e sintetizar informações e conhecimentos para ajudar a melhorar a tomada de decisão na prática médica e a política de saúde. Neste trabalho se apresenta um processo de avaliação de aquisição de sistemas de ar condicionado nos serviços de saúde, com base na definição de variáveis no campo da avaliação; essas variáveis vão quantificar o técnico e o funcional do equipamento em seu ambiente clínico e econômico. Da mesma forma, pretende-se promover nos departamentos clínicos de engenharia a aplicação de metodologias amplamente aceitas e eficácia que têm como objetivo principal a aquisição de tecnologias em saúde baseada em evidências.

Sleep disorders and driving licence: the current Italian legislation and medico-legal issues.

Road traffic accidents (RTA) are a serious issue in all industrialized countries and have dramatic social and healthcare-related implications. Fatigue (sleepiness) is the principal identifiable and preventable cause of road traffic accidents. Obstructive sleep apnoea syndrome (OSAS) and narcolepsy are two of the leading causes of excessive daytime sleepiness. In this article, the authors analyze the current Italian legislation regarding driving licence issuance and fitness to drive, in order to evaluate the potential implications of sleep disorders, particularly OSAS and narcolepsy. In European Legislation and in Italy, OSAS and narcolepsy are not included among the illnesses or invalidating conditions that limit the fitness to drive for driving licence issuance purposes. In fact, they are not included in the Annex III of the European Council Directive 91/439/EEC of the 29th of July 1991 on driving licences. Some Countries of the European Union (Belgium, France, Finland, Great Britain, the Netherlands, Spain and Sweden) had implemented the 91/439/EEC Directive with national restrictions on driving licence issuance policies in case of OSAS and narcolepsy. Given the well-established scientific evidence available, in Italy, the lack of legislation regulating the assessment of the psychophysical requisites for the issuance and renewal of driving licences of individuals affected by sleep disorders seems extremely worrying. Furthermore, the current lack of legal obligation in Italy for healthcare facilities to disclose such diagnoses to the organs responsible for issuing driving licences (such as the Motorizzazione Civile - the Department of motor vehicles) remains the subject of heated debate.

Mental Findings in Trauma Victims.

INTRODUCTION: In medico-legal evaluation of trauma patients, the bio-psychological effects of the trauma and the severity of the injuries require to be evaluated. In this study, assuming the fact that psychiatric assessment is not taken into consideration in physical trauma cases, we planned to show the presence of psychological trauma in our medico-legally evaluated patients who presented with different types of traumas and to review the mental findings and diagnoses in trauma victims. METHOD: We retrospectively analyzed the hospital records of 1975 patients aged 18 years or older who presented to the Department of Forensic Medicine at Dokuz Eylül University School of Medicine for medico-legal evaluation between 1999 and 2009. Psychiatric assessment was performed in 142 patients by the Department of Psychiatry. The data contained in medico-legal reports and patient records were then examined with respect to patients' age, gender, nature of traumatic events, psychiatric diagnoses, descriptive characteristics of the patients, severity of trauma and past history of mental disorder and trauma experience. Results of the medicolegal evaluations were also analyzed. RESULT: Of the 142 patients, 80 (56.3%) were female and their average age was 40.30±17.17 years. The most frequent traumatic events were traffic accidents (29.6%) and violence-related blunt force trauma (28.9%). When the distribution of the most common psychiatric diagnoses was examined, it was found that anxiety disorders were found in 69 cases (48.6%), adjustment disorders were found in 16 cases (11.3%) and mood disorders were found in 12 cases (8.5%). Among anxiety disorders, acute stress disorder (n=39) and post-traumatic stress disorder (PTSD) (n=27) were the most common ones. In 27 cases of the 142, it was determined that, psychiatric symptoms and findings did not meet the diagnostic criteria of any psychiatric disorder. Diagnosis of psychiatric disorder was not significantly related with traumatic experiences, comorbidity, marriage status, education level or lack of health insurance. CONCLUSION: We assume elucidating the presence of a psychological trauma is crucial not only for the health benefit but also for legal rights of the patient. The necessity of considering merely the international diagnostic criteria in determining the existence of psychiatric trauma and its severity level can bring forth some difficulties in medico-legal evaluation.