Model of medico-legal classification of disfigurement due to surgery, trauma, disease and medical intervention

Dosadašnja istraživanja: Sudsko-medicinski aspekt telesnih naruženja do sada su bili predmet malog broja naučnih istraživanja. Cilj ovog rada bio je da se ustanovi standardizovan instrument za sudsko-medicinsku procenu svih vrsta telesnih naruženja koji do sada nije postojao. Metod: Istraživanje je realizovano kroz četiri sukcesivne faze: prvu – formiranje nacrta liste naruženja koja su nastala kao posledica povreda, operacija, oboljenja i lečenja, drugu – procena nacrta liste naruženja od strane jedanaest eksperata (nastavnika plastične hirurgije) primenom Delfi metoda; treću u kojoj je prethodno formirana lista naruženja procenjivana od strane 51 lekara člana strukovnog udruženja hirurga specijalista plastične i rekonstruktivne hirurgije i četvrtu fazu u kojoj je lista odnosno skala naruženja iz prethodne, treće faze, primenjena na konkretne primere iz sudske prakse. Resultat: U prvoj fazi istraživanja opisano je 176 pojedinačnih telesnih naruženja hipotetički razvrstanih u četiri stepena gradacije.U drugoj fazi formirano je 217 naruženja koja su razvrstana u pet stepena (veoma malo, malo, srednje, veliko i veoma veliko naruženje). U trećoj fazi 217 naruženja je ponovo ocenjeno, pri čemu je stepen usaglašenosti sa drugom fazom bio visok a to je utvrđeno Mann-Withney testom.U četvrtoj fazi utvrđena je zadovoljavajuća usaglašenost formirane skale sa praksom sudskih veštaka u ocenjivanju stepena naruženja što je pokazala vrednost od 0,72 weighted kappa koeficijenta pri čemu je p<0,001. Zaključak: Istraživanjem u četiri faze konstruisana je petostepena ordinalna skala sa 217 naruženja koja je pokazala visok stepen usaglašenosti među kolegama i koja se može koristiti kao instrument za standardizovano, unificirano merenje naruženja u sudskim veštačenjima.Background: Medico-legal aspect of physical disfigurements has been subject to few scientific researches. The aim of this study is to establish a standardized instrument for forensic evaluation of all kinds of physical disfigurements, which has not existed until now. Methods: The research was conducted Result:176 individual physical disfigurements, hypothetically classified into four degrees of severity, were described i in four successive phases: the first one – drafting a list of disfigurements occurring as a result of injuries, surgery, illness and treatment; the second phase–evaluation of the draft of the disfigurement list provided by eleven experts (plastic surgery lecturers) using the Delphi method;the third one – during which 51 medical doctors - members of Serbian Association of Plastic, Reconstructive and Aesthetic Surgery - SRBPRASparticipated in evaluating previously formed list of disfigurements; and the fourth phase –during which the list, i.e. scale of disfigurements, formed in the previous, third phase, was applied to actual cases taken from the case-law. n the first phase of research. 217 disfigurements were established in the second phase Conclusion:The first five- , which were classified into five degrees of severity (very small, small, medium, large and very large disfigurements). In the third phase, 217 disfigurements were evaluated one more time, whereby the level of concordance with the second phase was very high, as shown by Mann-Whitney test. In the fourth phase a satisfactory level ofconformity of the established scale with the practice of court experts in assessing the severity of disfigurements was determined, as shown by the value of weighted kappa coefficient of 0.72, whereby p