31.20.39 Frequency of Stencil of Medico-legal Cases in Tertiary Hospital of Karachi

Original Article

 

Frequency and Causes of Medico-Legal Cases

Frequency of Stencil of Medico-legal Cases in Tertiary Hospital of Karachi

Roohi Ehsan1, Wasiq Ahmed1 and M. Faiz-uddin2

ABSTRACT

Objective: To determine the frequency and causes of medico-legal cases reported at three major hospitals of Karachi City.

Study Design: Retrospective study

Place and Duration of Study: This study was conducted at the three major tertiary care hospitals of Karachi, Abbasi Shaheed Hospital, Jinnah Postgraduate Medical Centre and Civil Hospital, from January 2007 to
December 2018.

Materials and Methods: Total of 306,406 medico-legal cases in twelve years retrospective study period received at three major hospitals of Karachi were overseen. The data was collected with the permission of concerned authorities. Assault, Intoxication, Accident and Sexual Assault medico-legal cases were included in the study. A detailed examination was conducted in each case to determine the different causes of injury.  Medico-legal deaths were excluded in the present study. The results were collected from the respective hospitals on a prepared structured Performa and were statistically analyzed using SPSS version 15.

Results: Out of all, in our study, among medico-legal cases reported (306,406), assault cases were the predominant 190,029 (62.01%), followed by Intoxication 60,233 (19.65%), accident 47,543 (15.51%) and sexual assault cases, 8,601 (2.8%) respectively. Among the outnumber assault medico-legal cases, the commonest one caused by hard and blunt object 135,086 and amongst accident cases were of road traffic accident 30,896. In sexual assault cases, rape cases were about 5,505 and in Intoxication cases, 54,270 Poisoning were at highest.

Conclusion: Hard and blunt injuries remained most common type of injury. Rape and poisoning cases are also recognized as most differentiating part of study. Enactment of the laws is the need of present period which can curtail accident cases and other medico-legal cases.

Key Words: Medic-legal, Assault, Injury, Karachi.

Citation of article: Ehsan R, Ahmed W, Faiz-uddin M. Frequency of Stencil of Medico-legal Cases in Tertiary Hospital of Karachi. Med Forum 2020;31(10):166-171.

 

 

INTRODUCTION

WHO defines Injury as those caused by acute exposure to physical agents such as mechanical injury, heat, electricity, chemical or ionizing radiation interacting with the body in amount and rate that exceed the threshold of human tolerance.1 It is important to clarify injuries for proper disbursement of justice in any system. The detailed and distinct record of injuries and other pointful particulars of the injured noted during the medico-legal examination form the footing of medico-legal diagnosis and epidemiological observations in the criminal justice system.2

 

 

1. Department of Forensic Medicine / Pathology2, Karachi Medical & Dental College, Karachi.

 

 

Correspondence: Dr. Roohi Ehsan, Associate Professor / Head, Department of Forensic Medicine, Karachi Medical & Dental College, Karachi.

Contact No: 0333-2528545

Email: roohimurtaza@yahoo.com

 

 

Received:    March, 2020

Accepted:    July, 2020

Printed:        October, 2020

 

 

 

In all government hospital a medico-legal officer or a casualty medical officer may be asked to examine an injured person. The details of examination must be entered in an accident register, which would be confidential record and if required by a court of law should be produced in the court.3 A case in general is said to be labelled “medico-legal” when the attending doctor by takes  history and doing examination of the patient comes to know that it is required by law enforcing agencies to make inquiry and affix the responsibility for the case.4 Medical officers or medico-legal officers are to be trained for how to write a “certificate” or “report”, so that all the competent facts to consummate the opinion are mentioned properly and with possible scientific deviation and limitation without giving undue weight age to the observed facts. The role of forensic expert is to help in the administering of justness. The qualities needed in forensic expert are qualification, training and experience to identify the problem with professional knowledge, detect accurately and decode the results properly to form a scientific conclusion and to furnish speculation on his findings. Results of study of frequency and types of medico-legal injuries showed that males are more likely to be involved in such cases compared to females.5 This could be due to the reasoning that males are more involved in outdoor work therefore they are involved in such mishaps or violation. Manner of injury is detected mainly on circumstantial evidence but to some extent the question can be solved by the medico-legal officer by examination of an injured person.6 One of the comportment of injury is assault which is due to any gesture or application of force causing harm to another person. In assault cases, apart from detail of injuries sometimes portrayal of pattern of tears in apparel is a valuable tool to determine the weapon of an offence, an examination of apparel is very valuable clue to ascertain the weapon of an offence.7-8 Accidents as the manner of injury account for in majority of cases, these injuries occur due to unplanned, uncontrolled event which has led to or could have led to injury to people. Attempted suicide, which is failing act of person to tail the life and self-inflicted injuries for the purpose of falsely stigmatize the other persons are also other manners of injury.9-10

Trauma is one of the most frequently encountered medical emergencies and second leading cause of death and disability.11-12 In Karachi, violence shares significantly to trauma cases, but RTA still contributes to most of the cases reported.13 Burn injuries, a unique form of trauma which is sometimes available, is categorized among the most severe injuries an individual can experience.

 

MATERIALS AND METHODS

The 12 years study was conducted from January 2007 to December 2018. Total of 306,406 medico-legal cases in this retrospective study period at three major hospitals of Karachi were overseen. The data was collected with the permission of authorities. Assault, Intoxication, Accident and Sexual Assault medico-legal cases were included in the study. A detailed examination was conducted in each case to determine the different causes of injury. Medico-legal deaths were excluded in the present study. The results were collected from the respective hospitals on a prepared structured Performa and were statistically analyzed using SPSS version 15.

RESULTS

Out of all medico-legal cases, assault (62.01%) was the predominant followed by intoxication (19.65%), accident (15.51%) and sexual assault (2.80%) cases. (Table 1, Graph 1)

Total of assault 190,029 cases, 135,086 by hard and blunt object followed by firearm 33,641, sharp object 9,414, explosive 3,795, maltreatment 926 and human bite 321 respectively. Number of brought dead cases recorded was 6,846. (Table 2, Graph 2)

 

Table No. 1: Total No. Of Medico-Legal cases (2007-2018)

Medico-Legal cases

Frequency

Percentage

Assault

190,029

62.01

Intoxication

60,233

19.65

Accident

47,543

15.51

Sexual assault

8,601

2.80

Total cases

306,406

100

Graph No.1: Percentage of Medico-Legal cases (2007-2018)

 

 

Table No. 2: Year wise Pattern of Assault cases in the study period (2007-2018)

Year

Hard & Blunt

Firearm

Sharp Edge

Explosive

Maltreatment

Human bite

Brought dead

Total

2007

12,241

2,891

890

344

142

60

542

17,110

2008

11,855

3,330

1,106

147

139

63

458

17,098

2009

11,770

3,388

1,075

266

164

44

541

17,248

2010

11,900

3,103

1,029

420

142

58

502

17,154

2011

11,394

3,719

729

342

105

9

722

17,020

2012

9,911

4,070

694

349

85

41

885

16,035

2013

10,355

4,367

583

952

41

21

1,304

17,623

2014

10,895

3,133

766

578

38

4

874

16,288

2015

12,253

2,398

735

204

20

3

486

16,099

2016

3,170

411

191

101

7

2

113

3,995

2017

13,620

1,566

769

27

29

7

219

16,237

2018

15,722

1,265

847

65

14

9

200

18,122

Total

135,086

33,641

9,414

3,795

926

321

6,846

190,029

 

 

 

Among the accident cases, most frequent was Road traffic accident cases 30,896, followed by 7,713 burn cases, 1,837 fall cases, 234 train accident cases, 206 factory cases and brought dead cases were 6,657. (Table 3, Graph 3). Total number of sexual assault cases 8,601, out of which 5,505 rape, sodomy 1,318 and under this heading 1,778 age estimation cases reported. (Table 4, Graph 4)

Amidst the 60,233 intoxication cases, 54,270 are of general poisoning followed by 4,724 of alcohol poisoning and 1,239 of drug poisoning. (Table/Graph 5)

 

 

 

Table No.3: Year wise Pattern of Accident cases in the study period (2007-2018)

Accident

Year

Road traffic

Burns

Fall

Railway

Factory

Brought Dead

Total

2007

2,981

582

252

21

25

469

4,330

2008

3,052

702

208

23

22

469

4,476

2009

3,052

807

136

26

34

550

4,605

2010

3,095

789

140

25

23

427

4,499

2011

2,360

720

149

10

13

352

3,604

2012

2,649

794

228

23

18

558

4,270

2013

2401

667

102

22

5

649

3,846

2014

2,282

631

97

27

2

625

3,664

2015

2,709

604

153

13

8

824

4,311

2016

793

483

0

4

39

271

1,590

2017

2,694

506

189

18

5

651

4,063

2018

2828

428

183

22

12

812

4,285

Total

30,896

7,713

1,837

234

206

6,657

47,543

Table No.4: Year wise Pattern of Sexual Assault cases in the study period (2007-2018)

SEXUAL ASSAULT

 

Rape

Sodomy

Age determination

Year

Active

Passive

Active

Passive

Male

Female

2007

122

222

45

57

70

83

2008

157

267

54

70

124

82

2009

90

239

33

54

55

70

2010

121

266

33

51

52

75

2011

145

278

43

57

72

69

2012

149

294

53

44

64

65

2013

177

325

34

45

61

81

2014

201

324

30

59

117

63

2015

204

342

85

61

122

70

2016

89

190

16

24

73

69

2017

254

331

37

72

39

77

2018

307

411

115

146

60

65

Total

5,505

1,318

1,778

Table No. 5: Year wise Pattern of Intoxication cases in the study period (2007-2018)

INTOXICATION

Year

Poison

Alcohol

Drugs

Total

2007

2,607

515

223

3,345

2008

2,844

575

179

3,598

2009

2,917

512

21

3,450

2010

3,119

609

214

3,942

2011

3,161

462

222

3,845

2012

6,618

342

110

7,070

2013

6779

289

53

7,121

2014

6247

405

62

6,714

2015

6350

290

74

6,714

2016

382

97

16

495

2017

6102

282

38

6,422

2018

7144

346

27

7,517

Total

54,270

4,724

1,239

60,233

 

 

Graph No.2: Frequency percentage of Assault cases in the study period

Graph No. 3: Frequency percentage of Accident cases in the study period

 

Graph No.4: Frequency percentage Sexual Assault cases in the study period

Graph 5: Frequency Percentage of Intoxication cases in the study period

 

 

DISCUSSION

In the present study, total numbers of 306,406 cases were studied, reported to the emergency department of Abbasi Shaheed Hospital, civil hospital and Jinnah postgraduate medical centre from January 2007 to December 2018. Predominant cases of assault were noted, following to assault were of intoxication. Poisoning outnumber among the intoxication cases. This might be due to the easy availability of the desired substance, low cost and also awareness of the effect of the substance. There is a gradual increase in the intoxication cases with the passage of years since 2007 till 2013. The number of intoxication was also eminent in year 2014 & 2015 but there was remarkable decline in the year 2016. Repeatedly the number of intoxication cases ascent in the year 2017 and 2018. After the intoxication cases we have accident cases, RTA being the highest. As Conditions of city roads are not perfect, untrained drivers and condition of the vehicle are also the factors that contribute the number of 30,896 RTA cases among accident cases.

In the first national injury survey in Pakistan, the yearly overall incidence of injury was found to be 41 injuries for every 1,000 persons converse to the low incidence in the western world.14 RTIs have a yearly incident of 15 injuries for every 1000 individuals and take lives of 500 and hurt 12,000 people in Pakistan every year.15 This is contrary to the low incidence in England and Wales where injury rate is 6.4/100,000 residents.16 Road traffic accidents may be associated to non-existence of safety rules, horrific road infrastructure, avoidance of helmets and seat belts use, lack of implementation of traffic laws and legislations, careless, rash and negligent driving and availability of limited trauma care facilities in Pakistan.17-18

According to 2011 and 2010 local public health data, the annual count of firearm deaths and injuries in New York City exceeded 2000; there were 366 firearm fatalities, 999 firearm hospitalizations and 691 firearm injury emergency department visits.19 Multiple factors leading into preeminent number of assault cases could be situation of the city, increase terrorism, suicidal bomb attacks, snatching, unemployment and above all are stress factors. Due to any of these we are in exasperating life and people are ready to beat, injured or even kill someone on minute quarrels. Easy availability of object of assault contributes a lot.

Study conducted by Romana et al on 3105 medico-legal cases revealed RTA (38%) followed by physical assault (32%) and sharp weapon injury (19%).20 These findings were homogenous with the study conducted at Nepal.21 On the contrary study conducted in UK, where prevalence of penetrating trauma was on highest with 86.8% and firearm injuries with 13.3%.16

Talha et al recognized that amongst the medico-legal cases at Bahawalpur, blunt weapon contributed 55% while firearm cases added only 2% to the total.22 Malik et al reporting 33% blunt injuries and 4% firearm injuries in medico-legal cases at Rawalpindi.23

Among the sexual assault medico-legal cases, we have rape and sodomy cases. Also constituted the age determination cases in both male and female. In the 12 year study period we have 5,505 rape cases and 1,318 sodomy cases. Saeed et al24 revealed that maximum number of medico-legal cases had the injuries due to physical assault 717(85.66%) followed by sexual assault in 54 (6.45%) cases in one-year study period of 2012. In Pakistan, the rape rate is 16.8 per 100,000 women with 10% being gang rapes according to 2013 National Crime Data Report. Worldwide the incidence is 225 rapes per 100,000 women in South Africa, 58 rapes per 100,000 women in United States and 22,000 rapes per year in India.25 In USA, 683,000 women are raped per year. This is in spite of the fact that sexual assault is the least reported of the violent crimes with only 16-39% being reported to the police.

CONCLUSION

Injuries can be prevented by proper education, awareness and training of safety standards which are required to be implemented strictly. Teaching and training facilities should be more improved for the staff which will be a benefaction for our population. Doctors who are involved in handling medico-legal cases need to be more trained.

Due to increase in violence and accidents the requisite for round the clock availability of medical experts in casualty and emergency departments to deal with the medico-legal cases is required. Emergency should be well equipped with the required equipments, antidotes, drugs and other remedies which are used for the treatment of victim especially in cases of poisoning and assault.

Providing facts about sexual abuse is one of the ways to raise awareness. Attentiveness of the facts is one of the several preventive measures that can be taken to assist you in making better decisions to keep you and someone you know safe.

Author’s Contribution:

Concept & Design of Study:

Roohi Ehsan

Drafting:

M. Faiz-uddin

Data Analysis:

Wasiq Ahmed

Revisiting Critically:

Roohi Ehsan, Wasiq Ahmed

Final Approval of version:

Roohi Ehsan

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

1.      Nasrullah M. Xiang H. The Epidemic of injuries in Pakistan; A Neglected Problem. J Pak Med Assoc 2008; 58(8):420-1

2.      Bhullar DS, Aggarwal KK. Medico Legal Diagnosis & Pattern of injuries with Sharp Weapons. JIAFM 2007;29(4):112-114.

3.      Franklin CA. Modi’s Medical Jurisprudence and Toxicol 21st edition 1988;273-295.

4.      Dorga TD, Rudra A. Medico legal injury. In: Dorga TD, Rudra A, editors. Lyons Medical Jurisprudence & Toxicology 11th ed. New Delhi: Law House;2007.p.367.

5.      Tajammul N, Chaudhry TH, Hanif S, Bhatti MA. Profile of medico legal cases at Jinnah Hospital Lahore. Ann King Edward Med Coll  2005; 11(3):332-335. 

6.      Kirishan V. Injuries medicolegal considerations and types. In: Kirishan V, editor. Text book of Forensic Medicine and Toxicology. 3rd ed. New Delhi: Elservier Publisher;2005.p.299.

7.      Hussain SS. Mechanical injuries. In: Hussain SS, editor. Medical Jurisprudence and Toxicology. 2nd ed. Lahore: The Caravan Book House; 1983.p.86.

8.      Dalal JS, et al. Clue of weapon from description of apparel; JPAFMAT 2005;5:47.

9.      Awan NR. Medical Aspects of law. In: Awan NR, editor. Principle and practice of Forensic Medicine. 1st ed. Lahore: subline Arts; 2002.p.25.

10.  Parikh CK. Mechanical injuries – General Concepts: self-inflicted wounds. In: Parikh CK, editor. Medical Jurisprudence. Forensic Medicine and Toxicology. 8th ed. New Delhi: CBS publishers & Distributers; 2002.p.4-24.

11.  WHO. World Report On Violence and Health [http://www.who.int/violence_injury_prevention/violence/world_report/en/introduction.pdf]

12.  Jamali AR. Trauma Care in Pakistan. J Pak Med Assoc 2008;58(3):102-103.

13.  Chotani HA, Razzak JA, Luby SP: Patterns of violence in Karachi, Pakistan. Injury prevention: journal of the international Society for Child and Adolescent injury Prevention 2002,8(1):57-59.

14.  Hassan Q, Bashir RM, Shah M. Physical trauma: A leading cause of medico-legal cases at DHQ Hospital Abbottabad. J Ayub Med Coll Abbottabad 2010;22(2):156-159.

15.  Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. Bull World Health Organ 2009; 87(4):246–246a.

16.  Sivarajasingam V, Morgan P, Matthews K, Shepherd J, Walker R. Trends in violence in England and Wales 2000–2004, an accident and emergency perspective. Injury 2008;40(8):820-5.

17.  Bhatti MA, Ajaib MK, Masud TI, Ali M. Road traffic injuries in Pakistan: Challenges in estimation through routine hospital data. J Ayub Med Coll Abbottabad 2008;20(3):108-111.

18.  Kayani A, Fleiter JJ, King MJ. Underreporting of road crashes in Pakistan and the role of fate. Traffic Injury Prevention 2014;15(1):34-39.

19.  Firearm Deaths and Injuries in New York City, Epi Research Report, New York City Department of Health and Mental Hygiene April 2013.

20.  Malik R, Atif I, Rashid F, Abbas M. An analsis of 3105 Medico Legal Cases at Tertiary Care Hospital, Rawalpindi. Pak J Med Sci 2017;33(4):
1-5.

21.  Timsinha S, Kar SM, Baral MP, Ranjitkar M. Profile of Pattern of Medico-Legal Cases in the Casualty of A Teaching Hospital of Western Region of Nepal. J Ind Acad Forensic Med 2015;37(1):46-49.

22.  Cheema TN, Qasim AP, Abaid t, Anjum H, Munir U,Abbas Q. Profile of Medicolegal Cases in the Rural Areas of District Bahawalpur. APMC 2019;13(1):104-7.

23.  Malik  R,  Atif  I,  Rashid  F,  Abbas  M.  An  analysis  of  3105. Medicolegal  cases  at  tertiary  care  hospital,  Rawalpindi.  Pak J Med Sci 2017; 33(4):926-30.

24.  Tariq SA, Qasim AP, Naeem M, Naheed K, Pal MI. Pattern of Female Medicolegal Cases Attending The Casualty Department of a Teaching Hospital. JUMDC 2014;5(1):20-25.

25.  Arif M, Ahmed M. Medicolegal Analysis of Reported Cases of Alleged Rape in Multan- A Two Year Study. PJMHS 2014;8(4):828-831.