Enhancing forensic medicine consultation in hospitals: Addressing limitations in file-based forensic evaluations of firearm injuries and proposing early interdisciplinary examination practices.

Abstract

Background: The forensic evaluation of non-fatal firearm injuries is crucial for legal proceedings; however, the quality and completeness of medical documentation often pose significant challenges. This study examines the limitations of retrospective, file-based forensic assessments and the impact of missing forensic and medical data on case evaluations. It also emphasizes the importance of early forensic consultation during hospitalization to improve documentation accuracy and legal outcomes.

Methods: A retrospective observational study was conducted on 245 firearm injury cases referred to a forensic medicine branch directorate in 2024. The study analyzed ballistic findings, deficiencies in medical documentation, assessments of vascular injuries, and the time required to complete forensic reports. Cases were categorized based on the completeness of medical records and the need for a second forensic evaluation.

Results: Differentiation between entry and exit wounds was missing in 53.9% of cases, and shooting distance assessment was documented in only one case. The type of ammunition was not recorded in 42.4% of cases. In 52.7% of cases, medical documentation was incomplete, with missing hospital records, imaging studies, and specialist consultations. Vascular injury assessments were absent in 43.0% of extremity injury cases. Although multiple projectile wounds were observed in 35.5% of cases, only 25.3% had sufficient documentation to evaluate each wound separately. The average time to complete a forensic report was 172.5 days for cases finalized in a single evaluation, while cases requiring additional medical records had a prolonged total duration of 230.8 days. Additionally, forensic consultation was absent in all cases, and forensic reports requested during hospitalization often resulted in preliminary rather than definitive reports.

Conclusion: The findings emphasize the critical role of emergency physicians in forensic evaluations, as missing or incomplete medical documentation significantly impairs the accuracy of forensic assessments and legal decisions. Implementing structured forensic consultation protocols within hospitals, ensuring the completeness of judicial documentation requests, and fostering interdisciplinary collaboration between forensic experts and emergency physicians can substantially improve the quality of forensic reporting. Establishing legal frameworks similar to on-site forensic evaluations used in fatal cases may further enhance documentation accuracy, accelerate forensic reporting, and lead to more reliable judicial outcomes.