Profile of Medico-Legal Cases in Accident & Emergency Department of SSKH, LHMC, New Delhi During Pre-Covid-19 and Covid-19 Periods

Medico-legal cases presented to the Accident & Emergency department vary from hospital to hospital. Profiling these cases from time to time provides an insight into the workload of medico-legal cases as well as what is going on in and around the locality. The present study was conducted at LHMC, New Delhi from January 2021 to June 2022 from the available records of MLCs from 1 st January 2019 to 31 st December 2021. Out of a total of 5702 MLCs, males were 85.77%. Victims of the age group 21–30 years formed the majority (36.30%) of the cases followed by age groups 31–40 years (25.44%). The time of incidence was between 6 p.m. and 11.59 p.m. in the majority (42.00%) cases. The time of reporting was between 6 p.m. and 11.59 p.m. in the majority (40.05%) of cases. A majority (56.92%) of the victims had reported within 1 hour of the incident. The cause was blunt force trauma in more than half (51.05%) cases, followed by RTA (17.93%) and poisoning (17.84%). In more than half (56.51%) cases, the manner was homicidal, followed by accidental including RTA (23.95%) and suicidal (19.35%). The surgery department was found involved in more than 2/3 (69.15%) cases, followed by Orthopaedics (31.85%), Medicine (20.199%) and ENT (19.52%). In 85.50% of cases, the victims were discharged within 24 hours. Hospital death in MLCs was 4.15% whereas 1.87% of victims were referred to other hospitals for further management.


Introduction
Analysis of the medico-legal cases presented to the casualty of a hospital gives an understanding of what unnatural things are happening to human beings in and around the particular locality.Lady Hardinge Medical College & Smt.S.K. Hospital is situated in the heart of Delhi, adjacent to Connaught Place catering for the people of New Delhi and central Delhi districts.However, two other large government hospitals, LNJP Hospital and Dr RML Hospital are also lying within a distance of 2-5 km.Therefore, patients turn to these hospitals because of their convenience and the kind of services available in these hospitals.In case of emergency medical needs, odd hours or medico-legal cases, the casualty remains the target place for the patients and police.Thus analysis of the medico-legal cases of a hospital from time to time helps to fulfill the medical needs of the nearby patients with the development of proper infrastructures, manpower, strategy and policies.

Aim and Objectives
Medical Record Department at Lady Hardinge Medical College & Smt.S.K. Hospital, New Delhi from January 2021 to June 2022 by collecting all the relevant data available in the MLC records of the study period using predesigned pro forma, then transferred to MS Excel sheet and analysed.

Magnitude of MLCs at LHMC, New Delhi
The total number of MLCs registered from 1 st January 2019 till 31 st December 2021 was 5702.Out of those, 2581 (45.26%)MLCs were found registered in the year 2019 (Pre-Covid year), 1955 (34.28%)MLCs were registered in the year 2020 and 1166 (20.44%)MLCs were registered in the year 2021 (Table I).Hence, there was a significant drop in MLCs during the Covid-19 period.

Sex
Out of a total of 5702 cases, males were found in 4891 (85.77%)MLCs whereas females were found in 810 (14.20%)MLCs.Only one transgender individual was involved in MLC as a case of RTA in the year 2021 (Table II).Our findings were similar to the studies reported by references [1]- [38].
However, the medico-legal cases in the paediatric age group in our study do not reflect the true figures as the data were collected from Sucheta Kripalini Hospital only.Lady Hardinge Medical College has a separate Kalavati Saran Children's Hospital to deal with paediatric age group patients.

Time of Incidence
Barring 93 MLCs where details were not available and 469 cases where natural disease cases were registered under  IV).

Person Presented the MLCs to the Hospital
The MLCs were presented to the hospital by the police in the majority (N = 1810; 31.74%)cases, followed by
Reference [12] reported that the majority (52.94%) of the MLCs were managed by the Surgery department, followed by 43.28% by the Orthopaedics department.Reference [21] also reported that the majority (93%) of MLCs were managed by the Surgery department, followed by the Orthopaedics and Neurosurgery departments, respectively.

Number of Department(s) Involved in Managing the MLCs
Out of a total of 5609 MLCs (5702-93), where details were available, the majority (N = 2562; 45.67%) cases were handled and managed by a single department whereas in 2299 (40.98%) cases, they were managed by two departments and in 748 (13.33%) cases, they were managed by more than two departments (Table XI).Reference [32] reported that in the majority (64.93%) of MLCs, opinions were sought from a single department, followed by two departments (26.72%) and more than two departments (8.35%), respectively.

Duration of Stay in the Hospital in MLCs
Out of a total of 5609 MLCs (5702-93), where details were available, in 4796 (85.50%) cases, the stay of the victims in the hospital was less than 24 hours whereas in 813 (14.49%) cases, the stay in the hospital was more than 24 hours and maximum up to 97 days (Table XIII).Most of the patients who stayed in the hospital for longer durations were victims of RTA with bone fractures.
Reference [23] reported that the majority (90.89%) of the victims of MLCs were discharged from the hospital within 1 week of admission to the hospital.
Reference [13] reported that 0.6% of victims of MLCs were referred to other higher hospitals for treatment and LA.M.A cases were 1.63%.Reference [14] reported that  Reference [20] reported that 80.69% of MLCs were discharged, deaths were 9.68% whereas 4.45% of MLCs were referred to other hospitals for further management.Reference [24] reported that 66.1% of MLCs were discharged, deaths were 9.9% whereas 11.6% of MLCs were LA.M.A. Reference [30] reported that 78.4% of MLCs were discharged, deaths were 9.59% whereas 4.69% MLCs were referred to other hospitals for further management.Reference reported that 81.84% of MLCs were discharged, 12.03% were referred to other hospitals for further management whereas deaths were 5.9%.

Conclusion
The Accident & Emergency Department of SSKH, Lady Hardinge Medical College deals with a reasonable number of MLCs due to the large urban population and easy accessibility from nearby areas.There was a significant drop in MLCs during Covid periods 2020 & 2021 from non-Covid period 2019.As the busiest hours to deal with MLCs were found between 6 p.m. and 11.59 p.m., hence, the concerned Surgery, Orthopaedics, Medicine and ENT departments should remain vigilant with well-trained manpower during those hours.The majority of the MLCs were found blunt force trauma caused by homicidal assault, followed by RTA and poisoning respectively that reflected the mindset of the people living in the region.Referral of 1.87% MLCs to other hospitals for further management and death of 4.15% victims of MLCs need to be addressed properly with the overall augmentation of medical facilities and services.The clinical forensic medicine branch should be developed well to deal with MLC documentation for the administration of proper justice in the court of law at a later stage.

TABLE I :
Number of Medico-Legal Cases Table V).Thus evening hour was the busiest period to deal with medico-legal cases at the Accident & Emergency Department at SSKH.

TABLE II :
Gender of the Individuals in Medico-Legal Cases

TABLE III :
Age Groups of the Individuals in Medico-Legal Cases Sl.No.

TABLE V :
Time of Reporting at the Hospital

TABLE VI :
Duration between Time of Incidence and Time of Reporting

TABLE VIII :
Alleged History of Causation in Medico-Legal Cases

TABLE IX :
Manner of Causation in Medico-Legal Cases Profile of Medico-Legal Cases in Accident & Emergency Department of SSKH, LHMC, New Delhi During Pre-Covid-19

TABLE X :
Department Involved in Managing the MLCs

TABLE XIII :
Duration of Stay in the Hospital in Medico-Legal Cases

TABLE XIV :
Outcome in the Medico-Legal Cases