CAUSES AND CHARACTERISTICS OF DIAGNOSIS DISCREPANCIES IN BRAIN INJURIES AND OTHER MECHANICAL TRAUMAS

A. Bondarev, A. Pădure, E. Lungu, P. Glavan

Abstract: The diagnostic process entails the accurate identification of diseases and traumas present in a patient and remains a paramount responsibility of the physician. the quality and correctness of the diagnosis depends not only on comprehensive investigations and symptom presence but also on the clinician’s expertise in interpreting the clinical data, contextualizing findings, and objectively evaluating them. The current study is a focused retrospective analysis. A total number of 152 medico-legal records associated with died in hospitals patients, coupled with their medical records spanning 5 years (2009–2013), were critically reviewed. All post-mortem examinations were conducted at the regional divisions of the Center of Forensic Medicine from the Republic of Moldova. The study aimed to assess causes and occurrence conditions of discrepancies between clinical and medico-legal diagnoses in brain injuries and other mechanical traumas. Diagnosis discrepancies were influenced mostly by subjective causes than by objective ones. Among the objective causes, the most common were severe state of the patient, short in-hospital stay and the presence of atypical clinical symptoms or conditions that masked typical symptoms. The most frequently identified subjective causes were: underestimation of results from instrumental examinations; underestimation of clinical examination; over- and underestimation of patient’s history. Brain injury is often under-diagnosed being combined with drunkenness as masking condition.
Keywords: clinical diagnosis, medico-legal diagnosis, medical care quality, discrepancy, subjective causes, objective causes, brain injury.