Neurological injuries and their medicolegal aspects as a result of criminal and non-criminal acts in a Pakistani sample

Abstract Background Traumatic brain and spine injuries make up a significant fraction of cases presented for forensic examination. Such cases involve violent head injuries, including blunt head injuries and penetrating head injuries, and non-violent injuries as well. Our purpose is to evaluate the main clinical, radiological and medicolegal features of these cases and to determine the relationship between the variables associated with such cases. Materials & methods We retrospectively analyzed patients admitted in a 1 year period from 1st January 2019 to 1st January, 2020 at the Department of Neurosurgery at the Lahore General Hospital, Pakistan. Data contained medical and medicolegal reports. Severity of brain injury was analyzed according to GCS (Glasgow Coma Scale). Statistical analysis was done via GraphPad Prism 8.4.1.676 software. Five interesting cases are also discussed in further detail. Results A total of 61 cases were analyzed. 50 were male (82.0%) and 11 were female (18.0%), representing an age range from 2.5 years to 80 years. Among the 61 cases, 28 patients had mild brain injuries (45.9%), 13 had moderate brain injuries (21.3%) and 20 had severe brain injuries (32.8%). 4 patients had spinal injuries. The most common outcome was complete recovery in 38 patients (62.3%). Blunt head trauma was the most frequent type of trauma (50.8%), and all cases of this type of trauma were due to criminal assault. The most common mechanism of injury was direct impact. Intracranial hemorrhage was the most common type of intracranial lesion (27/86 injuries). The cause of death was severe head injury in 20 patients and exacerbation of moderate head injuries in 3 patients. The variables Gender and Medical Management have no significant association with any other variable or with each other. Other variables, such as the Severity of Injuries, Medical Outcome, Type of Incident (blunt force trauma, penetrative force trauma, etc.) and the Nature of the Case (criminal or non-criminal) were significantly associated with each other, with statistical significance being defined at p Conclusion Based on our results, the conclusion is the need to identify severe head injuries early and timely management is necessary as these injuries are the most common cause of death. In addition, mild to moderate head injuries must be cautiously managed to prevent the exacerbation of traumatic brain injury. Furthermore, case information (whether criminal or otherwise and cause of injury) can be deemed necessary for the neurosurgeon who is responsible for the management of the injuries.