Quality control of injury reports issued by Primary Health Care and Emergency Medical Services in the province of Córdoba

Abstract

IntroductionInjury reports are medico-legal documents containing the required information about injuries (from accidental, criminal or self-inflicted origin) to be delivered to the judicial authority. Nevertheless, forensic routine work suggests a high rate of inadequate or erroneous injury reports. This hinders forensic evaluation and, consequently, damage repair. The main objective of this paper is to evaluate the quality of the completion of injury reports issued by Primary Care and Emergency services in Córdoba, Spain, by using a new scale, as well as to identify the most prevalent mistakes made during that completion. Material and methodsDescriptive cross-sectional and retrospective study conducted on 127 injury reports issued by Primary Care and Emergency services selected from the archive of the Institute of Legal Medicine and Forensic Science of Córdoba, using consecutive sampling, between 1 January 2015 and 30 June 2015. A quality scale of our own creation was then applied to them. ResultsThe analysis showed that 18.1% of injury reports are of low or very low quality, while the majority (78.7%) are considered as intermediate quality. Nevertheless, most of them are very poorly described – with the lowest scores – in relation to strictly medico-legal parts; the description of the injury, including type, dimension and evolutionary stage. ConclusionsThe study shows the poor quality of the injury reports issued by Primary Care and Emergency services within the province of Córdoba. Further strategies are needed in order to improve the completion of these medico-legal documents.