Study of medico-legal cases admitted at tertiary care hospital

In every hospital, Casualty department deals with the emergency cases. These emergency cases also includes medicolegal cases like road traffic accidents, Poisoning, assaults are dealt in the casualty and detailed MLC report is made here after giving the proper primary treatment and life saving measures. The police is informed about MLC as early as possible. Important preventive measures like drawing public attention and awareness towards traumatic casualties can help in the prevention or management of unnatural (medicolegal cases). Considering the importance of above points, a one year retrospective study from 1st March 2018 to 31st March 2019 was conducted in the Casualty department of Tertiary Care Centre.


Introduction
A Medicolegal case is a case of injury or illness where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land. 1 Injury is defined under Sec. 44 I. P. C. as any harm whatever illegally caused to any person in body, mind, reputation or property. 2 Casualty department is the backbone of every hospital as all the medical and surgical emergencies first report to emergency and also deals with a huge number of medicolegal cases which comprises accidents, assaults, burns, poisoning, suicide, homicide, any suspicious deaths, cases referred from Police or court, etc. 3 Medicolegal cases forms a major component of the emergencies brought to the casualty department of the hospital. Profiling of medicolegal cases is an integral aspect for the prevention of preventable casualties in future and to study the burden of the medicolegal cases in area. Hospital based study of such cases is important because it may give an insight into value system and crime profile of the society. 4 Road traffic accidents have been increasing at an alarming rate throughout the world. 5 By the year 2020,it is estimated that in countries like India, mortality from injuries will be more than those from communicable diseases. 6 The present study was conducted to find out the different categories of medicolegal cases and characteristics of the victims documented at the Casualty of B.K.L. Walawalkar Hospital, Savarde and also to study the duties of medical and paramedical staff in handling /treating such cases. The collected data was analysed and depicted in form of tables, charts, etc. by using various parameters and compared with other similar studies. Ethical approval letter was taken from the Local Ethical Committed of the institution.

Inclusion criteria
All the cases registered as medicolegal in the MLC record register of the casualty department of B.K.L.Walawalkar Hospital, Savarde were included in this study.

Exclusion criteria
Cases which are not medicolegal cases and cases in which history is incomplete were excluded from this study.      From the table no 5 it is shown in most of the cases the mode of occurrence was accidental i.e. 592 cases (87%) followed by suicidal and homicidal mode of occurrence.   From the Table 8, most of the patients (90.90%) were discharged within a week, followed by 8-15 days (7.78 %).

Discussion
Medicolegal cases represent the major group of all the emergencies presented to the Casualty department of any hospital. The social, demographic and epidemiological transition due to rapid urbanization, mechanization and industrialization has augmented the frequency of such cases. 7 In the present study a total of 681 MLCs were reported to Casualty department of a Tertiary Care hospital in Konkan region during the period of 1 st March 2018 to 31 st March 2019.
In our study, Male victims -502(75.36%) outnumbered Female victims -179(24.64%). This is in consistence with the study conducted by Hussain SN. 12 Males are more vulnerable to accident or injuries contributing to majority of MLCs.
In the present study we observed that age group 21-30 years (26.13 %) was most commonly involved in medicolegal cases, followed by 31-40 years (18.79 %). Similar findings were reported by Garg V, 8 Malik Y, 13 Marri MZ 14 Hussain SN [12] , as it is the most working age group in the society and is most active phase of life, physically and mentally.
It was observed that the Rural victims constituted (90.01%) and the Urban victims were 8.51%. These findings are consistent with the study conducted by Garg V. 8 It can be explained by the fact that our hospital /medical college is located in the village and hence the patients from rural areas are more than the person residing in the urban areas.
Majority of this medicolegal cases took place in the afternoon and evening time between 12. 00 pm -6.00 pm (37.44%%) whereas minimum number of medicolegal cases occurred in between 12. 00 am -6.00 am (13.50%).Similar findings were seen in the study conducted by Shyam Sundar Mina. 15 Maximum incidences of MLCs took place in between 12. 00 pm -6.00 pm, because people are involved maximally into their work at this time, leading to large number of MLCs during this time. Minimum number of MLCs are seen in between 12:00am 6:00am because people are fresh and stress free during this time of day hence least incidents takes place during the morning hours.
Season wise distribution of cases revealed that majority i.e.( 41.55%) presented during Summer season. This finding is in contrast with the findings of Timsinha 11 and Qudisia. 17 Summer months are more active period of the year, during this period people deals with numerous working activities making people more prone to injuries. This factors influences the increasing number of MLCs during summer.
In our study, it was observed that majority of victims (31. 57%) were reported to Casualty withinan hour of incident.Our findings are consistent with the study conducted by Yadav A 17 and Sidappa SC, 18 followed by 26.72% of cases were reported between 2-4 hrs. This finding of our study was in contrast with the other studies.
Most of the patients (90.89%) were discharged within a week, followed by 8-15 days (7.48 %). Maximum number of cases (79.58 %) were discharged in a Clinically satisfactory condition, (15.27 %) took Discharged against Medical Advice (DAMA), (3.52%)were Transferred to higher centre and (1.46 %) Died out of the injuries sustained and their complications. This is in consistence with the of Garg V 8 and Abhishek Yadav. 19 This shows the awareness and health consciousness among the society of this region.

Conclusion
This study shows the burden of medicolegal cases in a Tertiary Care hospital, the need of proper documentation and treatment in case of MLCs. The basic preventive measures to overcome the burden of MLCs includes education, uniform enforcement of law and order, prehospital care, safety standards training, etc. are important. This study helped to know the trend of occurrence of cases in the area.

Source of funding
None.