Pattern of Medico-legal Cases among Pediatric Patients Presenting to the Emergency Department of a Tertiary Care Center in Nepal: An Observational Study

TL;DR

This study examines the types and patterns of medico-legal cases among children in Nepal's emergency departments, highlighting road accidents and self-harm as major issues.

Contribution

The study provides localized data on pediatric medico-legal cases in Nepal, identifying key incident types and demographic patterns.

Findings

Road traffic accidents and suicide/self-harm were the most common causes of pediatric medico-legal cases.

Adolescents aged 14-17 years and males were disproportionately affected by these incidents.

Poisoning, particularly with pesticides, was a significant factor in suicide attempts and accidental cases.

Abstract

Pediatric medico-legal cases, encompassing injuries and other unnatural events, pose a significant public health burden, particularly in low- and middle-income countries like Nepal. Lack of comprehensive, localized data on the spectrum of these cases presenting to emergency departments hinders the development of targeted prevention and management strategies. This study aimed to describe the pattern of medico-legal cases among pediatric patients at a tertiary care center in Nepal.

A retrospective cross-sectional study was conducted by reviewing the medical charts of pediatric patients (under 18 years) registered as medico-legal cases in the Emergency Department of Tribhuvan University Teaching Hospital from December 2022 to January 2023. Data on demographics, case type, and clinical details were extracted and analyzed using descriptive statistics.

Out of 2,936 total medico-legal cases, 297 (10.11%) were pediatric cases. Based on types of incidents, there were 109 (36.70%) road traffic accidents, 68 (22.89%) suicide and self-harm, 47 (15.82%) falls, and 46 (15.49%) physical assaults. Adolescents aged 14-17 years accounted for 147 (49.49%) cases, and males accounted for 182 (61.15%) cases. There were 57 (83.8%) suicide attempts with poisoning, and 10 (52.63%) accidental poisonings with pesticides. Males accounted for 77 (70.64%) of road traffic accidents and 34 (73.91%) of physical assaults, while females accounted for 39 (57.35%) of suicide/self-harm cases.

Road traffic accidents and suicide/self-harm are the leading causes of pediatric medico-legal presentations in this tertiary care setting. The distinct patterns observed across different age and gender groups underscore the need for targeted, evidence-based interventions in injury prevention, mental health support, and public safety to protect this vulnerable population in Nepal.