Revision of the medicolegal assessment criteria in hypovolemic patients

Abstract

Trauma scoring systems are often used for the determination of the severity level of the lesion and the clinical status in medico-legal assessment of the trauma patient. Trauma scoring systems are used also for the determination of the life-threatening conditions. Blood loss of more than 20% was reported as the only criterion for life-threatening conditions in the acute hypovolemia. The objective of this study was to revise the medico-legal assessment criteria in the patients with acute hypovolemia and to discuss other parameters, which might be used in the determination of the severity level of the clinical status.The medical reports of the patients with acute hypovolemia due to the trauma, which were sent by the judicial authorities and by other departments of our medical faculty to the department of the forensic medicine between 1999 and 2009, were evaluated. The characteristics such as age, gender, severity of the injury, type of the trauma, history of liquid replacement or blood transfusion, vital signs, type of the physical injury, injured region of the body, presence of any chronic disease were assessed and recorded.The mean age of the included 155 patients was 34.70 ± 16.08 years (3-87 years). 118 (76%) of patients were males and 37 females (24%). Regarding the event types, road accidents were the most common cause (60.0%) and it was followed by sharp object injuries (18.7%) and firearm injuries (11.6%). 27.7% of the subjects received 2 units blood and blood products transfusion and 21.3% only 1 unit transfusion. According to the results of the medico-legal assessment, 84.5% of the patients had life-threatening conditions.While evaluating the severity of the clinical conditions in the hypovolemic patients, to report only the losses in percentage causes problems and limitations. Therefore, in respect of the medico-legal assessment of the hypovolemic patients, we believe that it would be more appropriate to use the physiological trauma scoring systems (like Revised Trauma Score) instead of the anatomic scoring systems.

Use of the Trauma and Injury Severity Score (TRISS) as a Predictor of Patient Outcome in Cases of Trauma Presenting in the Trauma and Emergency Department of a Tertiary Care Institute

“…The AUROC was > 0.5 for RTS (0.971) and TRISS (0.955). These results were consistent with the results from previous studies [7,8,10,24].…”

“…We found maximum mortality in the ISS group 25-40 (n=63), whereas the ISS group 16-24 had the greatest number of survivors (n=12). Recent studies showed similar findings [8,12,17,[22][23][24]. Garkaz et al [25] showed a higher mean ISS for non-survivors (56.32 ± 25.02) than our study (28.74 ± 8.38), but the explanations for the findings were not given.…”

“…Tools like trauma scores precisely quantify the severity of trauma and outcome probability, which are critical in understanding the gap between problems and the definitive management of trauma patients [7]. Trauma scores are beneficial in framing opinions regarding the nature of the injuries in medico-legal cases [7,8]. Forensic medicine experts are routinely called upon to examine injuries in hospitalised trauma patients.…”

How Shock Index Helps the Assessment of Hypovolemic Shock : A Scoping Review

“…A typical example of this type of shock is polytrauma, most commonly caused by traffic accidents and fall from height, Bleeding diffuse, hypothermia, And acidosis cause coagulopathy death (Al Aseri et al, 2020) Typical causes of traumatic hypovolemic shock are burns and chemical burns. Hypovolemic shock in a sense narrow and traumatic hypovolemic shock lost fluid Which significant without bleeding (Can et al, 2019) . Narrower sense hypovolemic shock , namely external or internal fluid loss coupled with inadequate fluid intake (Daş et al, 2020) .…”

“…Narrower sense hypovolemic shock , namely external or internal fluid loss coupled with inadequate fluid intake (Daş et al, 2020) . This can be caused by hyperthermia, vomit And diarrhea persistent (for example, cholera), or lost fluid due to uncompensated renal impairment (eg, diabetes insipidus, hyperosmolar diabetic coma) (Standl et al, 2018) Blood loss of more than 20% was reported as the only criterion for life-threatening conditions in acute hypovolemia (Can et al, 2019). Clinical manifestations of hypovolemic shock do not coexist in the patient's symptoms clinical seen clear If volume circulation reduce more from 15% (Gupta & Nature, 2021) .…”