Pattern, practices, and challenges in medicolegal cases at a rural tertiary care emergency department: a prospective original research study from western India

Pattern, practices, and challenges in medicolegal cases at a rural tertiary care emergency department: a prospective original research study from western India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pattern, practices, and challenges in medicolegal cases at a rural tertiary care emergency department: a prospective original research study from western India Dr. Swapnil S Agarwal, Dr. Darshan D Galoria, Dr. Pradip S Rana, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9564254/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Medicolegal casework is an important component of emergency medical practice, but the practical handling of such cases is often affected by inadequate training, operational uncertainty, and coordination gaps between healthcare providers and law-enforcing agencies. Objective : To study the pattern of medicolegal cases received at a rural tertiary care emergency department, evaluate the practices followed in their examination and reporting, and identify challenges faced during execution of medicolegal duties. Methods : A prospective, record-based original research study was conducted at the emergency department of Shree Krishna Hospital, Karamsad, Gujarat, from 1 July 2023 to 30 June 2024. Data were collected from the medicolegal register, clinical case records, medicolegal reports, and investigation reports. All medicolegal and potential medicolegal cases were included, except cases brought only for DNA sample collection. Results : A total of 1614 cases were analyzed. Adults above 18 years constituted 83% of cases, and males comprised 70%. Accidental cases formed the largest category (66.9%), followed by assault (9.1%), suicidal cases (8.3%), natural cases (7.5%), and other medicolegal categories (8.2%). Among accidental cases, road traffic accidents accounted for 70.89%. The overall institutional practices in handling medicolegal cases were fair, but important practical challenges included police registration delays, difficulties related to postmortem-linked dead body handling, and unnecessary referrals from peripheral centres. Conclusion : Medicolegal case handling at the study centre was generally satisfactory; however, important operational gaps remain. Standardized protocols, regular training, and improved coordination with police and referral centres may further strengthen medicolegal services in rural tertiary care settings. medicolegal case emergency department rural tertiary care centre forensic medicine clinical forensic practice Figures Figure 1 Figure 2 Introduction Medicolegal cases are encountered routinely in emergency departments and require simultaneous attention to patient care, legal documentation, evidence preservation, and communication with investigating authorities. In practice, the attending doctor is expected to identify whether a case has medicolegal implications, initiate appropriate reporting, document findings accurately, preserve relevant samples, and issue medicolegal opinions when necessary [1]. These responsibilities are especially challenging in busy emergency settings, where treatment priorities, incomplete or misleading history, poor practical training, and lack of administrative clarity may interfere with ideal practice. In India, much of the medicolegal workload is handled at trauma, casualty, and emergency units. Previous hospital-based studies have consistently shown that young adult males constitute the majority of medicolegal cases and that road traffic accidents account for the largest share, followed by assault, falls, burns, and poisoning [2-8]. However, most available studies primarily describe epidemiological patterns and give limited attention to the actual practices followed during handling of such cases or the specific operational challenges faced by healthcare professionals. The Department of Forensic Medicine and Toxicology at our institute undertook medicolegal work in coordination with the Department of Emergency Medicine from 2023 onward. This offered an opportunity to systematically study not only the pattern of medicolegal cases received but also the practical aspects of their handling. The present original research was therefore designed to evaluate the pattern, practices, and challenges related to medicolegal case management in a rural tertiary care emergency department. Methods This prospective, record-based original research study was conducted in the Department of Emergency Medicine, Shree Krishna Hospital, Karamsad, Gujarat, over a one-year period from 1 July 2023 to 30 June 2024. The hospital is a rural tertiary care centre receiving a substantial burden of emergency and medicolegal work. Inclusion criteria comprised all medicolegal and potential medicolegal cases presenting directly to the hospital for treatment, brought for medicolegal examination, referred from other centres for examination or treatment within the purview of medicolegal work, and brought-dead cases. Cases brought only for DNA sample collection were excluded from the study. Data were collected from the medicolegal register maintained in the emergency department, along with the corresponding clinical files, medicolegal reports, and investigation records, using a predesigned case record form. Variables analyzed included age, sex, manner of occurrence, place and mechanism of incident, and issues encountered during case handling and reporting. To ascertain the challenges faced during handling of medicolegal duties, a written questionnaire was given to the faculty and residents of Department of Emergency Medicine & Department of Forensic Medicine & Toxicology, who examine the medicolegal cases brought to our institute The study was entirely record-based. Institutional Ethics Committee approval with waiver of consent was obtained, as no direct patient interaction was involved and no personal identifiers were recorded during data extraction. Confidentiality of patient information was maintained throughout the study. Results A total of 1614 cases fulfilled the inclusion criteria during the study period. Adults above 18 years constituted the majority of the cases (83%) is illustrated in Fig. 1., while pediatric cases accounted for the remaining proportion. Males represented 70% of the total study population, indicating a clear male predominance among medicolegal cases. With respect to manner of occurrence as shown in table no. 1 accidental cases formed the largest category and accounted for 66.9% of all medicolegal cases. Assault cases constituted 9.1%, suicidal cases 8.3%, natural cases 7.5%, and other categories such as age estimation, sexual offences, and alcohol intoxication together accounted for 8.2%. These findings indicate that accidents remain the major contributor to medicolegal workload in the emergency department. As mentioned in table no. 2 among accidental cases, road traffic accidents constituted 70.89%, making them the single largest subgroup. Domestic accidents accounted for 13.0%, industrial accidents for 6.2%, and the remaining cases were classified under miscellaneous categories such as snakebite, railway injury, bee sting, scorpion sting, and lightning . In domestic accidents, falls constituted the most frequent mechanism, whereas machine-related trauma and electrocution were important contributors among industrial injuries. Within assault cases, blunt force trauma was the most common mechanism of injury. The data also showed in figure no. 2 that a smaller proportion of cases involved sharp force trauma and other forms of assault-related injuries. Overall, the pattern of cases demonstrated a predominance of accidental injuries over intentional injuries and self-harm related cases. Assessment of practical handling revealed that the overall practices followed in examining and reporting medicolegal cases were fair. However, several operational challenges were identified during the study period. These included delay or difficulty in police registration of cases, issues related to handing over of dead bodies without postmortem examination in selected situations, and unnecessary or unclear referrals from peripheral health centres. These challenges affected workflow and created uncertainty despite overall acceptable institutional practice. Discussion The present study demonstrates that medicolegal work at a rural tertiary care emergency department is dominated by accidental cases, particularly road traffic accidents, with a clear predominance of adult males. This pattern is consistent with findings from several Indian hospital-based studies that have similarly reported high proportions of young male victims and road traffic accidents as the leading category of medicolegal workload [2-8]. The demographic pattern likely reflects greater outdoor mobility, occupational exposure, vehicular travel, and risk-taking behavior among males in the productive age group. The high proportion of road traffic accidents in the present study reinforces the continued public health and forensic importance of traffic-related trauma in India. At the same time, the study also demonstrates that medicolegal services in emergency departments must be prepared to manage a broad range of other categories, including assault, suicide-related cases, poisoning, industrial trauma, burns, and miscellaneous incidents such as snakebite and railway injuries. A major strength of this study is that it extends beyond simple epidemiological description and addresses the operational realities of medicolegal case handling. Although practices at the study centre were generally fair, the identified challenges underline the need for stronger systems support. Delay in police intimation or registration can complicate reporting and medico-legal documentation. Similarly, ambiguity regarding postmortem-linked procedures and peripheral referrals can create avoidable confusion for both treating teams and forensic personnel. These findings support the need for regular sensitization of emergency medical officers, better communication pathways with law-enforcing agencies, and institution-specific standard operating procedures for medico-legal work. Similar challenges have been reported in earlier studies. Gurupur et al. noted poor medico-legal knowledge among emergency personnel and difficulties such as reluctance to register cases, treatment delays, court testimony, and managing police and the public [9]. Mostafa et al. also reported pressure from relatives, psychological stress, and difficulty in handling forensic evidence among physicians, with better knowledge and practice among those who had received postgraduate forensic training [10]. These studies reinforce the need for structured training and stronger institutional support in medico-legal case management. The findings are especially relevant for rural tertiary care centres, where medicolegal responsibilities may be shared between emergency medicine and forensic medicine teams and where referral patterns from peripheral centres can influence workflow. By documenting both pattern and practical barriers, the study contributes useful evidence for service improvement in clinical forensic medicine. The study has certain limitations. It was conducted at a single centre and relied on hospital records; therefore, the findings may not fully represent the pattern or practices at other institutions. In addition, some operational issues were inferred from records and institutional experience rather than measured through a separate validated assessment tool. Despite these limitations, the study offers meaningful insight into real-world medicolegal practice in a rural tertiary care setting. Conclusion This original research study showed that medicolegal cases at the study centre were predominantly accidental, with road traffic accidents constituting the largest subgroup, and that adult males formed the majority of cases. The institutional practices followed in medicolegal examination and reporting were generally fair, but important operational challenges persisted, particularly in relation to police coordination, postmortem-related procedures, and referrals from peripheral centres. Development of standardized protocols, periodic training of healthcare personnel, and improved coordination between emergency medicine, forensic medicine, and law-enforcing agencies may strengthen medicolegal service delivery and reduce practical difficulties in such settings. Abbreviations MLC: Medico-legal case; RTA: Road traffic accident Declarations Ethics approval and consent to participate The study was approved by the Institutional Ethics Committee [Institutional Ethical Committee 2, Bhaikaka University, Karamsad, Gujrat, India; letter number IEC/BU/145/Faculty/25/175/2022 dated 10/06/2023] with waiver of informed consent because it was entirely record-based and involved no direct patient interaction. Consent for publication Not applicable. Funding No external funding was received for this study. Expenditure related to data collection and analysis was borne by the investigators. Clinical Trial Number: Not applicable References Aggrawal A. Textbook of Forensic Medicine and Toxicology. 2nd ed. New Delhi: Arya Publishing House; 2022. Manju L, Beevi PN. A study on medicolegal cases attended in a tertiary care hospital in south Kerala. International Journal of Health Sciences & Research. 2018 Nov; 8(11): 257-260. Saji S, Nayak VC. A Profile on Medico-legal Cases Reported at a Tertiary Care Centre in the Coastal Town of South Karnataka. Journal of Indian Academy of Forensic Medicine. 2024 Jun;46(2):217-20. Siddappa SC, Datta A. A study pattern of medico-legal cases treated at a tertiary care hospital in central Karnataka. Indian J Forensic Comm Med. 2015 Jan 1;2(4):193-7. Brahmankar TR, Sharma SK. A record-based study of frequency and pattern of medico-legal cases reported at a tertiary care hospital in Miraj. International Journal of Community Medicine and Public Health. 2017 Apr;4(4):1348-52. Waghmode AH, Bodkha P, Chavan RR. Study of medico-legal cases admitted at tertiary care hospital. IP International Journal of Forensic Medicine and Toxicological Sciences. 2020 January-March;5(1):1-4. Trangadia MM, Mehta RA, Rada NH, Gupta BD. Profile of medico-legal cases in tertiary care hospital in Jamnagar, Gujarat: Retrospective study of one year. J Res Med Den Sci. 2014 Jan 1;2(4):57-62. Singh JP, Bansal MK, Yadav M. Profile of medico-legal cases in casualty of a Tertiary Care Hospital in Delhi. Indian Internet Journal of Forensic Medicine & Toxicology. 2021 April-June; 19(2): 27-31. Gurupur N, Saldanha S, Shet N, Sharma P. Challenges faced in handling the medico-legal cases in a selected teaching hospital. Int. J. Commun. Med. Public Health. 2019 Sep; 6:3771-5. Mostafa E, Awny MM, Siam WA, Shehata SA. Knowledge, attitude and practice of an Egyptian physician sample towards dealing with medico-legal cases and forensic evidence. Zagazig Journal of Forensic Medicine and Toxicology. 2022 Jul 1;20(2):1-28. Tables Table 1: Distribution of medicolegal cases according to their manner of occurrence (n = 1614) Type of MLC [manner] Frequency Percent Natural (sudden or attended deaths) 121 7.5 Unnatural Accidental 1079 66.9 Assault 147 9.1 Suicidal 134 8.3 Others [age estimation, sexual offences and alcohol intoxication] 133 8.2 Most of the cases presenting as MLC were accidental (67%) in nature, followed by alleged assault (09%). Table 2: Distribution of accidental cases on basis of site of incident (n =1079) Distribution of cases labelled as accident Frequency Percent Domestic 145 13.0 Road traffic accident (RTA) 765 70.89 Industrial 67 6.2 Poisoning [external site] 9 0.83 Others [railway etc.] 93 8.61 Most of the cases under accidental category had vehicular involvement (RTA, 71%) followed by domestic ones (13%). All 9 cases of accidental poisoning (1% only) were reported to be outside home. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9564254","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":632646831,"identity":"fd1c6311-5fcc-4ae0-a618-ee9c263c3c33","order_by":0,"name":"Dr. Swapnil S Agarwal","email":"","orcid":"","institution":"Bhaikaka University","correspondingAuthor":false,"prefix":"Dr.","firstName":"Swapnil","middleName":"S","lastName":"Agarwal","suffix":""},{"id":632646832,"identity":"4eb22df8-3fdd-4a78-b34c-67cb8b3a93ef","order_by":1,"name":"Dr. Darshan D Galoria","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYDCCAwwGQNKCgYGZgfEBkMXDR6QWCZAWZhCLh414LQwMbBCSkA6+A8wbGL/USMiZtzM/q/yaYyfDxsD88NENPFokD7AVMMsckzCWOcxmdlt2WzLQYWzGxjl4tBgc4DFglmCTSJzBzGB2W3IbM1ALD5s0YS3/QFrYvxVLbqsnTgvjxzaQFh4zxo/bDhPWInmYreAwY5+EsQQzT7E047bjPGzMBPzCd7x548Mf32zkJPiPb/z4c1u1PT9788PH+LQAY5DhMA+MzQMVIQgYf6AzRsEoGAWjYBQgAwC6/T15JejGmgAAAABJRU5ErkJggg==","orcid":"","institution":"Bhaikaka University","correspondingAuthor":true,"prefix":"Dr.","firstName":"Darshan","middleName":"D","lastName":"Galoria","suffix":""},{"id":632646833,"identity":"81c8c155-6542-4a3b-bc95-ed4f35736376","order_by":2,"name":"Dr. Pradip S Rana","email":"","orcid":"","institution":"Bhaikaka University","correspondingAuthor":false,"prefix":"Dr.","firstName":"Pradip","middleName":"S","lastName":"Rana","suffix":""},{"id":632646834,"identity":"04a3f794-41d7-4f61-bd60-a1c8ce835e94","order_by":3,"name":"Dr. Preeti Tiwari","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"Dr.","firstName":"Preeti","middleName":"","lastName":"Tiwari","suffix":""},{"id":632646835,"identity":"04980b4a-121f-4fd2-8ace-063481c558a7","order_by":4,"name":"Dr. Nisha J Sonaria","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"Dr.","firstName":"Nisha","middleName":"J","lastName":"Sonaria","suffix":""},{"id":632646836,"identity":"86e01b6b-f53d-4602-a7ec-2d53197128ea","order_by":5,"name":"Dr. Prashant Verma","email":"","orcid":"","institution":"Bhaikaka University","correspondingAuthor":false,"prefix":"Dr.","firstName":"Prashant","middleName":"","lastName":"Verma","suffix":""},{"id":632646837,"identity":"797ef824-2008-4e6e-904d-d586219eaac2","order_by":6,"name":"Dr. Srushti Shukla","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"Dr.","firstName":"Srushti","middleName":"","lastName":"Shukla","suffix":""},{"id":632646838,"identity":"928237d8-3ca3-4eb7-8382-3db3f9279e25","order_by":7,"name":"Dr. Dhara Goswami","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"Dr.","firstName":"Dhara","middleName":"","lastName":"Goswami","suffix":""},{"id":632646839,"identity":"1b52686d-ddb1-4074-bfc3-7b2ee7286acc","order_by":8,"name":"Dr. Arijit A Datta","email":"","orcid":"","institution":"Bhaikaka University","correspondingAuthor":false,"prefix":"Dr.","firstName":"Arijit","middleName":"A","lastName":"Datta","suffix":""}],"badges":[],"createdAt":"2026-04-29 10:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9564254/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9564254/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108841067,"identity":"85bf2b61-e5ea-4163-8bca-02bcdc276715","added_by":"auto","created_at":"2026-05-09 01:02:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25214,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAge wise distribution of medicolegal cases (n = 1614).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the data above, maximum number of reported medicolegal cases belonged to more than 18 years of age (83%).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9564254/v1/2a7609cf57f8a98658b2d345.png"},{"id":108841068,"identity":"d3765da8-b6ce-4561-9169-a35eb124c07c","added_by":"auto","created_at":"2026-05-09 01:02:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37162,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of cases of assault as per mechanism of injury (n= 147)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlunt force trauma dominated cases of assaults (78%; n=147) followed by sharp instrument injuries (19%; n=147).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9564254/v1/503b0e751a0e283d7ba0b50c.png"},{"id":108977219,"identity":"61d5b3f3-79e3-4a17-bb5a-a54ab1df60ae","added_by":"auto","created_at":"2026-05-11 11:30:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":193307,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9564254/v1/11bb1f17-6429-4bb5-a3f6-709f31a44daf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pattern, practices, and challenges in medicolegal cases at a rural tertiary care emergency department: a prospective original research study from western India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedicolegal cases are encountered routinely in emergency departments and require simultaneous attention to patient care, legal documentation, evidence preservation, and communication with investigating authorities. In practice, the attending doctor is expected to identify whether a case has medicolegal implications, initiate appropriate reporting, document findings accurately, preserve relevant samples, and issue medicolegal opinions when necessary [1]. These responsibilities are especially challenging in busy emergency settings, where treatment priorities, incomplete or misleading history, poor practical training, and lack of administrative clarity may interfere with ideal practice.\u003c/p\u003e\n\u003cp\u003eIn India, much of the medicolegal workload is handled at trauma, casualty, and emergency units. Previous hospital-based studies have consistently shown that young adult males constitute the majority of medicolegal cases and that road traffic accidents account for the largest share, followed by assault, falls, burns, and poisoning [2-8]. However, most available studies primarily describe epidemiological patterns and give limited attention to the actual practices followed during handling of such cases or the specific operational challenges faced by healthcare professionals.\u003c/p\u003e\n\u003cp\u003eThe Department of Forensic Medicine and Toxicology at our institute undertook medicolegal work in coordination with the Department of Emergency Medicine from 2023 onward. This offered an opportunity to systematically study not only the pattern of medicolegal cases received but also the practical aspects of their handling. The present original research was therefore designed to evaluate the pattern, practices, and challenges related to medicolegal case management in a rural tertiary care emergency department.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis prospective, record-based original research study was conducted in the Department of Emergency Medicine, Shree Krishna Hospital, Karamsad, Gujarat, over a one-year period from 1 July 2023 to 30 June 2024. The hospital is a rural tertiary care centre receiving a substantial burden of emergency and medicolegal work.\u003c/p\u003e\n\u003cp\u003eInclusion criteria comprised all medicolegal and potential medicolegal cases presenting directly to the hospital for treatment, brought for medicolegal examination, referred from other centres for examination or treatment within the purview of medicolegal work, and brought-dead cases. Cases brought only for DNA sample collection were excluded from the study.\u003c/p\u003e\n\u003cp\u003eData were collected from the medicolegal register maintained in the emergency department, along with the corresponding clinical files, medicolegal reports, and investigation records, using a predesigned case record form. Variables analyzed included age, sex, manner of occurrence, place and mechanism of incident, and issues encountered during case handling and reporting.\u003c/p\u003e\n\u003cp\u003eTo ascertain the challenges faced during handling of medicolegal duties, a written questionnaire was given to the faculty and residents of Department of Emergency Medicine \u0026amp; Department of Forensic Medicine \u0026amp; Toxicology, who examine the medicolegal cases brought to our institute\u003c/p\u003e\n\u003cp\u003eThe study was entirely record-based. Institutional Ethics Committee approval with waiver of consent was obtained, as no direct patient interaction was involved and no personal identifiers were recorded during data extraction. Confidentiality of patient information was maintained throughout the study.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1614 cases fulfilled the inclusion criteria during the study period. Adults above 18 years constituted the majority of the cases (83%) is illustrated in Fig. 1., while pediatric cases accounted for the remaining proportion. Males represented 70% of the total study population, indicating a clear male predominance among medicolegal cases.\u003c/p\u003e\n\u003cp\u003eWith respect to manner of occurrence as shown in table no. 1 accidental cases formed the largest category and accounted for 66.9% of all medicolegal cases. Assault cases constituted 9.1%, suicidal cases 8.3%, natural cases 7.5%, and other categories such as age estimation, sexual offences, and alcohol intoxication together accounted for 8.2%. These findings indicate that accidents remain the major contributor to medicolegal workload in the emergency department.\u003c/p\u003e\n\u003cp\u003eAs mentioned in table no. 2 among accidental cases, road traffic accidents constituted 70.89%, making them the single largest subgroup. Domestic accidents accounted for 13.0%, industrial accidents for 6.2%, and the remaining cases were classified under miscellaneous categories such as snakebite, railway injury, bee sting, scorpion sting, and lightning . In domestic accidents, falls constituted the most frequent mechanism, whereas machine-related trauma and electrocution were important contributors among industrial injuries.\u003c/p\u003e\n\u003cp\u003eWithin assault cases, blunt force trauma was the most common mechanism of injury. The data also showed in figure no. 2 that a smaller proportion of cases involved sharp force trauma and other forms of assault-related injuries. Overall, the pattern of cases demonstrated a predominance of accidental injuries over intentional injuries and self-harm related cases.\u003c/p\u003e\n\u003cp\u003eAssessment of practical handling revealed that the overall practices followed in examining and reporting medicolegal cases were fair. However, several operational challenges were identified during the study period. These included delay or difficulty in police registration of cases, issues related to handing over of dead bodies without postmortem examination in selected situations, and unnecessary or unclear referrals from peripheral health centres. These challenges affected workflow and created uncertainty despite overall acceptable institutional practice.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study demonstrates that medicolegal work at a rural tertiary care emergency department is dominated by accidental cases, particularly road traffic accidents, with a clear predominance of adult males. This pattern is consistent with findings from several Indian hospital-based studies that have similarly reported high proportions of young male victims and road traffic accidents as the leading category of medicolegal workload [2-8]. The demographic pattern likely reflects greater outdoor mobility, occupational exposure, vehicular travel, and risk-taking behavior among males in the productive age group.\u003c/p\u003e\n\u003cp\u003eThe high proportion of road traffic accidents in the present study reinforces the continued public health and forensic importance of traffic-related trauma in India. At the same time, the study also demonstrates that medicolegal services in emergency departments must be prepared to manage a broad range of other categories, including assault, suicide-related cases, poisoning, industrial trauma, burns, and miscellaneous incidents such as snakebite and railway injuries.\u003c/p\u003e\n\u003cp\u003eA major strength of this study is that it extends beyond simple epidemiological description and addresses the operational realities of medicolegal case handling. Although practices at the study centre were generally fair, the identified challenges underline the need for stronger systems support. Delay in police intimation or registration can complicate reporting and medico-legal documentation. Similarly, ambiguity regarding postmortem-linked procedures and peripheral referrals can create avoidable confusion for both treating teams and forensic personnel. These findings support the need for regular sensitization of emergency medical officers, better communication pathways with law-enforcing agencies, and institution-specific standard operating procedures for medico-legal work.\u003c/p\u003e\n\u003cp\u003eSimilar challenges have been reported in earlier studies. Gurupur et al. noted poor medico-legal knowledge among emergency personnel and difficulties such as reluctance to register cases, treatment delays, court testimony, and managing police and the public [9]. Mostafa et al. also reported pressure from relatives, psychological stress, and difficulty in handling forensic evidence among physicians, with better knowledge and practice among those who had received postgraduate forensic training [10]. These studies reinforce the need for structured training and stronger institutional support in medico-legal case management.\u003c/p\u003e\n\u003cp\u003eThe findings are especially relevant for rural tertiary care centres, where medicolegal responsibilities may be shared between emergency medicine and forensic medicine teams and where referral patterns from peripheral centres can influence workflow. By documenting both pattern and practical barriers, the study contributes useful evidence for service improvement in clinical forensic medicine.\u003c/p\u003e\n\u003cp\u003eThe study has certain limitations. It was conducted at a single centre and relied on hospital records; therefore, the findings may not fully represent the pattern or practices at other institutions. In addition, some operational issues were inferred from records and institutional experience rather than measured through a separate validated assessment tool. Despite these limitations, the study offers meaningful insight into real-world medicolegal practice in a rural tertiary care setting.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis original research study showed that medicolegal cases at the study centre were predominantly accidental, with road traffic accidents constituting the largest subgroup, and that adult males formed the majority of cases. The institutional practices followed in medicolegal examination and reporting were generally fair, but important operational challenges persisted, particularly in relation to police coordination, postmortem-related procedures, and referrals from peripheral centres. Development of standardized protocols, periodic training of healthcare personnel, and improved coordination between emergency medicine, forensic medicine, and law-enforcing agencies may strengthen medicolegal service delivery and reduce practical difficulties in such settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMLC: Medico-legal case; RTA: Road traffic accident\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee [Institutional Ethical Committee 2, Bhaikaka University, Karamsad, Gujrat, India; letter number IEC/BU/145/Faculty/25/175/2022 dated 10/06/2023] with waiver of informed consent because it was entirely record-based and involved no direct patient interaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funding was received for this study. Expenditure related to data collection and analysis was borne by the investigators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAggrawal A. Textbook of Forensic Medicine and Toxicology. 2nd ed. New Delhi: Arya Publishing House; 2022.\u003c/li\u003e\n\u003cli\u003eManju L, Beevi PN. A study on medicolegal cases attended in a tertiary care hospital in south Kerala. International Journal of Health Sciences \u0026amp; Research. 2018 Nov; 8(11): 257-260.\u003c/li\u003e\n\u003cli\u003eSaji S, Nayak VC. A Profile on Medico-legal Cases Reported at a Tertiary Care Centre in the Coastal Town of South Karnataka. Journal of Indian Academy of Forensic Medicine. 2024 Jun;46(2):217-20.\u003c/li\u003e\n\u003cli\u003eSiddappa SC, Datta A. A study pattern of medico-legal cases treated at a tertiary care hospital in central Karnataka. Indian J Forensic Comm Med. 2015 Jan 1;2(4):193-7.\u003c/li\u003e\n\u003cli\u003eBrahmankar TR, Sharma SK. A record-based study of frequency and pattern of medico-legal cases reported at a tertiary care hospital in Miraj. International Journal of Community Medicine and Public Health. 2017 Apr;4(4):1348-52.\u003c/li\u003e\n\u003cli\u003eWaghmode AH, Bodkha P, Chavan RR. Study of medico-legal cases admitted at tertiary care hospital. IP International Journal of Forensic Medicine and Toxicological Sciences. 2020 January-March;5(1):1-4.\u003c/li\u003e\n\u003cli\u003eTrangadia MM, Mehta RA, Rada NH, Gupta BD. Profile of medico-legal cases in tertiary care hospital in Jamnagar, Gujarat: Retrospective study of one year. J Res Med Den Sci. 2014 Jan 1;2(4):57-62.\u003c/li\u003e\n\u003cli\u003eSingh JP, Bansal MK, Yadav M. Profile of medico-legal cases in casualty of a Tertiary Care Hospital in Delhi. Indian Internet Journal of Forensic Medicine \u0026amp; Toxicology. 2021 April-June; 19(2): 27-31.\u003c/li\u003e\n\u003cli\u003eGurupur N, Saldanha S, Shet N, Sharma P. Challenges faced in handling the medico-legal cases in a selected teaching hospital. Int. J. Commun. Med. Public Health. 2019 Sep; 6:3771-5.\u003c/li\u003e\n\u003cli\u003eMostafa E, Awny MM, Siam WA, Shehata SA. Knowledge, attitude and practice of an Egyptian physician sample towards dealing with medico-legal cases and forensic evidence. Zagazig Journal of Forensic Medicine and Toxicology. 2022 Jul 1;20(2):1-28.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Distribution of medicolegal cases according to their manner of occurrence (n = 1614)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of MLC [manner]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNatural\u003c/strong\u003e (sudden or attended deaths)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnnatural\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAccidental\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAssault\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSuicidal\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 384px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOthers\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[age estimation, sexual offences and alcohol intoxication]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMost of the cases presenting as MLC were accidental (67%) in nature, followed by alleged assault (09%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: \u0026nbsp; Distribution of accidental cases on basis of site of incident (n =1079)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"516\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 338px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDistribution of cases labelled as accident\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 338px;\"\u003e\n \u003cp\u003eDomestic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 338px;\"\u003e\n \u003cp\u003eRoad traffic accident (RTA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e70.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 338px;\"\u003e\n \u003cp\u003eIndustrial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 338px;\"\u003e\n \u003cp\u003ePoisoning [external site]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 338px;\"\u003e\n \u003cp\u003eOthers [railway etc.]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 101px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e8.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMost of the cases under accidental category had vehicular involvement (RTA, 71%) followed by domestic ones (13%). All 9 cases of accidental poisoning (1% only) were reported to be outside home.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"medicolegal case, emergency department, rural tertiary care centre, forensic medicine, clinical forensic practice","lastPublishedDoi":"10.21203/rs.3.rs-9564254/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9564254/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Medicolegal casework is an important component of emergency medical practice, but the practical handling of such cases is often affected by inadequate training, operational uncertainty, and coordination gaps between healthcare providers and law-enforcing agencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To study the pattern of medicolegal cases received at a rural tertiary care emergency department, evaluate the practices followed in their examination and reporting, and identify challenges faced during execution of medicolegal duties.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A prospective, record-based original research study was conducted at the emergency department of Shree Krishna Hospital, Karamsad, Gujarat, from 1 July 2023 to 30 June 2024. Data were collected from the medicolegal register, clinical case records, medicolegal reports, and investigation reports. All medicolegal and potential medicolegal cases were included, except cases brought only for DNA sample collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 1614 cases were analyzed. Adults above 18 years constituted 83% of cases, and males comprised 70%. Accidental cases formed the largest category (66.9%), followed by assault (9.1%), suicidal cases (8.3%), natural cases (7.5%), and other medicolegal categories (8.2%). Among accidental cases, road traffic accidents accounted for 70.89%. The overall institutional practices in handling medicolegal cases were fair, but important practical challenges included police registration delays, difficulties related to postmortem-linked dead body handling, and unnecessary referrals from peripheral centres.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Medicolegal case handling at the study centre was generally satisfactory; however, important operational gaps remain. Standardized protocols, regular training, and improved coordination with police and referral centres may further strengthen medicolegal services in rural tertiary care settings.\u003c/p\u003e","manuscriptTitle":"Pattern, practices, and challenges in medicolegal cases at a rural tertiary care emergency department: a prospective original research study from western India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-09 01:02:00","doi":"10.21203/rs.3.rs-9564254/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3e1d263-7722-43b4-ac18-d784d2c47981","owner":[],"postedDate":"May 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T01:02:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-09 01:02:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9564254","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9564254","identity":"rs-9564254","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}