This
review highlights the persistent variability in medico-legal assessment
practices of bodily injury, despite the availability of recognized protocols,
recommendations, and methodological tools [1,5,6]. The analyzed studies
demonstrate that this variability affects the interpretation of injuries, the
drafting of medico-legal documents, and the assessment of functional and
psychological consequences, with direct implications for judicial and
compensation decisions [2,3,4,8,9]. Inter-expert variability emerges as a
recurrent finding, particularly in complex situations such as intentional
violence, torture, or cognitive trauma [2,3,11,15]. Even in contexts where
international reference frameworks exist, such as the Istanbul Protocol, a low
level of inter-observer agreement has been reported, underscoring the
limitations of non-standardized application and the dependence on individual
expert experience [2]. These findings confirm that the mere availability of
methodological guidelines is insufficient to ensure homogeneous assessments in
the absence of specific training and structured tools [4,5,6]. The quality of
initial medical certificates and judicial expert reports represents another
major issue. The included studies reveal substantial heterogeneity in the
structure, content, and medico-legal reasoning of produced documents, with
methodological shortcomings that may weaken their evidentiary value [8,9]. This
drafting variability is particularly concerning in judicial contexts, where
medical documents often constitute key elements in judges’ appraisal of bodily
injury [9].
Several
studies emphasize the value of standardized tools and structured reporting
templates in improving the reproducibility and reliability of expert
assessments [4,10]. The use of validated assessment grids or standardized
report formats appears to reduce subjectivity and promote better inter-expert
consistency [4,5]. However, these studies also stress the importance of
preserving individualized expert judgment, which is essential to account for
the specific clinical, functional, and contextual characteristics of each
victim [1,5,6]. The challenge therefore lies in achieving a balance between
methodological standardization and personalized assessment of bodily injury.
The specific contexts addressed in the included studies—road traffic injuries,
maxillofacial trauma, pediatrics, sexual violence, and migration—illustrate the
increasing complexity of contemporary medico-legal situations
[7,10,12,13,14,15]. These contexts require specialized skills and adaptation of
assessment methods, further reinforcing the need for continuous training of
physicians involved in forensic medicine and close multidisciplinary
collaboration with judicial and social stakeholders [12,13,14]. Finally, the
heterogeneity observed across countries and medico-legal systems highlights the
absence of a harmonized international framework for bodily injury assessment
[6,16]. Organizational, legal, and cultural disparities influence practices and
represent a barrier to the comparability of expert evaluations. Nevertheless,
consensus initiatives and recent efforts toward shared reference frameworks
offer promising perspectives for improving the coherence and equity of
medico-legal expertise [1,5].
This
review has certain limitations. It is based on a limited number of studies with
substantial methodological heterogeneity, precluding quantitative
meta-analysis. In addition, most of the included studies are observational or
descriptive, exposing the findings to potential bias [2,3,8]. Nevertheless,
this diversity reflects the reality of medico-legal practices and supports the
relevance of a qualitative and synthetic approach [4,5]. The findings of this
review support the development and validation of standardized assessment tools,
the improvement of initial and continuing education in forensic medicine, and
the progressive harmonization of practices at both national and international
levels [1,4,5,6]. Future multicenter and comparative studies are needed to
assess the actual impact of these approaches on the reliability and equity of
medico-legal assessment of bodily injury [16]. These methodological challenges
are also observed in specific contexts such as the assessment of alleged
injuries among asylum seekers. A four-year retrospective study highlights the
importance of rigorous documentation of physical evidence to support accounts
of torture and abuse [17]. The absence of clear definitions, such as wound
depth in many medico-legal reports, represents a major methodological
shortcoming, emphasizing the need for more precise documentation of bodily
injuries [18]. Furthermore, the psychological and physical sequelae of torture
survivors require medico-legal expertise that integrates both clinical and psychological
elements, reinforcing the idea that assessments should not be limited to
traditional scales focused solely on isolated physical criteria [19]. Finally,
a multidisciplinary approach incorporating specialized examinations and
instrumental tools has been proposed to improve the quality of physical abuse
assessments, in line with recommendations advocating methodological
harmonization across medico-legal practices [20].