Caner BEŞKOÇ, Hızır ASLIYÜKSEK
Turkish Journal of Public Health - 2026;24(1):380-390
Objective: This study aimed to evaluate the forensic outcomes of medical leave reports and to examine the relationship between board decisions and factors such as report duration, diagnosis-report consistency, medical documentation, treatment consistency, and guideline-duration compatibility. Methods: This retrospective analytical study included medico-legal files submitted to the 7th Specialization Board of the Council of Forensic Medicine between 2019 and 2024 for expert evaluation of the scientific appropriateness of medical leave reports. Therefore, the study population represents selected disputed or questioned cases rather than routine medical leave reports. After excluding cases with missing data, 99 cases were analyzed. Board decisions were classified as "appropriate/partially appropriate" or "not appropriate." Statistical analyses included the Mann-Whitney U test, chi-square test, and binary logistic regression. The logistic regression model was fitted using the Enter method, and the variables entered into the model were explicitly reported. Because guideline-duration compatibility showed complete separation, Firth penalized logistic regression was applied as an additional sensitivity analysis.Results: Of the cases, 59.6% were female (n=59) and 40.4% were male (n=40). The median report duration was 20 days (IQR: 8.5-30.0). Overall, 83.8% of reports were considered not scientifically appropriate, 15.2% appropriate, and 1.0% partially appropriate. The most common reasons were mismatch between diagnosis and leave duration (53.5%) and insufficient medical evidence (41.4%). Report duration was significantly longer in the not appropriate group. Board decisions were significantly associated with report duration, diagnosis-report consistency, medical documentation, treatment consistency, guideline compatibility, age group, and report type (p<0.050). In multivariable analysis, longer report duration was associated with higher odds of a "not appropriate" decision. In the Firth penalized regression model, lack of consistency with the treatment process was also associated with the outcome; however, the estimate was unstable and imprecise, and should therefore be interpreted cautiously.Conclusion: Report duration, diagnosis-report consistency, medical documentation, treatment consistency, and guideline compatibility were associated with board decisions in this selected medico-legal sample. These findings should be interpreted within the context of selected disputed cases referred for forensic evaluation and should not be generalized to all routine medical leave reports.
