GA/T 1555-2019Forensic sciences - Technical specifications for appraisal of succeeding treatment of personal injury victims (English PDF)

4.1 Evaluation Principles

The assessment items should be determined based on the facts of the injured person, the clinical diagnosis and treatment specifications, and follow-up diagnosis and treatment items.

If there is content that is not specified in this code, but follow-up diagnosis and treatment are indeed needed, according to the actual situation and combined with the recommendations of clinical and rehabilitation doctors, to evaluate and confirm.

4.2 Evaluation timing

Should be caused directly by trauma to the body injury or indeed the complications caused by the injury, after diagnosis and treatment to achieve the general principles of clinical medicine the recognized symptoms and signs are basically stable. It is generally performed after the disability assessment conditions are available, that is, after the end of the clinical treatment period.

5.1 Scalp contusion/scalp laceration

No special treatment is generally required after healing.

5.2 Avulsion of the scalp/scalp burns

The follow-up diagnosis and treatment items for scalp injuries of different nature and scope are as follows.

a) A large area (greater than 5cm in diameter) of the scalp is peeled off, and the skin can be transplanted after the granulation tissue grows;

b) Full-thickness scalp burns (diameter greater than 5cm), scar formation on the scalp, two-stage incision and skin grafting are required;

c) Wigs can be provided for those with large hair defects.

5.3 Skull fracture

The follow-up diagnosis and treatment items are as follows.

a) Those who have broken bone fragments or skull defects (after half a year) need to undergo secondary skull repair;

b) Patients with epilepsy need systemic antiepileptic treatment (specifically follow the doctor's order or refer to the "Clinical Diagnosis and Treatment Guide for Epilepsy").

5.4 Skull base fracture

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing;

b) patients with epilepsy need systemic antiepileptic treatment;

c) If the cerebrospinal fluid ear and nasal leak are not cured for a long time, the cerebrospinal fluid ear and nasal leak repair is feasible.

5.5 Mild head injury

No special treatment is generally required after healing.

5.6 Brain contusion and laceration

The prognosis is related to the location, degree and extent of brain injury. The follow-up diagnosis and treatment items for different prognosis are as follows.

a) No special treatment is required for persons without dysfunction;

b) Skull defect requires a second craniotomy;

c) Patients with combined epilepsy, aphasia, hydrocephalus after trauma, and limb dysfunction, see related clauses;

d) Those with psychiatric symptoms shall be determined based on the clinical situation and clinical evaluation opinions.

5.7 Epidural Hematoma/Subdural Hematoma/Intracerebral Hematoma

The prognosis is related to the location, degree and extent of brain injury. The follow-up diagnosis and treatment items for different prognosis are as follows.

a) Generally no special treatment is required after recovery;

b) Skull defects require secondary surgery;

c) Patients with combined epilepsy, aphasia, hydrocephalus after trauma, and limb dysfunction, see related clauses;

d) Those with psychiatric symptoms shall be determined based on the clinical situation and clinical evaluation opinions.

5.8 Open head injury

The follow-up diagnosis and treatment items are as follows.

a) Healers generally do not need special treatment;

b) Skull defects require secondary surgery;

c) Patients with combined epilepsy, aphasia, hydrocephalus after trauma, and limb dysfunction, see related clauses;

d) Those with psychiatric symptoms shall be determined based on the clinical situation and clinical evaluation opinions.

5.9 Cranial Nerve Injury

The follow-up diagnosis and treatment items are as follows.

a) Healers generally do not need special treatment;

b) Patients with combined dysfunction can be equipped with clinical aids (such as glasses, hearing aids, etc.), which are determined according to the specific clinical situation.

5.10 Traumatic epilepsy

The follow-up diagnosis and treatment items are as follows.

a) long-term systemic anti-epileptic drug treatment (specifically follow the doctor's order or refer to the "Clinical Diagnosis and Treatment Guide Epilepsy Volume");

b) Surgical treatment is available when necessary.

5.11 Hemiplegia/monoparesis

The follow-up diagnosis and treatment items are as follows.

a) Rehabilitation training is required, and assistive devices and necessary rehabilitation equipment can be configured, as shown in Table A.1 in Appendix A;

b) those with dysfunction of the stool, see 5.14 for details;

c) Apparatus (such as wheelchairs, walkers, etc.) that can assist in sitting up, transferring, or moving when necessary, as shown in Table A.1;

d) measures to prevent infection;

e) Other circumstances are determined based on clinical situation and clinical evaluation opinions.

5.12 Hydrocephalus after trauma

Surgical treatment can be performed if necessary, and it is determined according to the clinical situation and clinical evaluation opinions.

5.13 Aphasia after trauma

Determined based on clinical situation and clinical evaluation opinions.

5.14 Second incontinence or dysfunction

The follow-up diagnosis and treatment items are as follows.

a) Need defecation and urination care and supplies, including defecation care (such as Kailulu, etc.) and urination management (such as. disposable pads, diapers, Diapers and disposable urinary catheters, etc. can also be calculated monthly);

b) Periodic review.

5.15 Plant survival

The follow-up diagnosis and treatment items are as follows.

a) Respiratory management (including respiratory clearance/assisted sputum removal, etc.);

b) those with dysfunction of the stool, see 5.14 for details;

c) measures to prevent infection;

d) measures and supplies to prevent limb contractures;

e) nutritional measures inside and outside the intestine;

f) Others can be determined based on the clinical situation and clinical evaluation opinions.

6.1 Eyelid Damage

The follow-up diagnosis and treatment items are as follows.

a) Mild injury, usually no special treatment is needed after healing;

b) Relevant plastic surgery is available for those with eyelid deformity.

6.2 Eyebrow defect

The follow-up diagnosis and treatment items are as follows.

a) minor defects generally do not require special treatment;

b) If necessary, plastic surgery such as skin flap transplantation and defect repair can be performed.

6.3 Orbital injury

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after mild orbital injury is stable;

b) Severe cases can be treated with orbital wall reconstruction.

6.4 Vision and visual impairment

The follow-up diagnosis and treatment items are as follows.

a) surgical treatment according to clinical conditions;

b) Vision aids such as glasses can be provided if necessary, and prosthetic eyes can be provided for those with eye defects;

c) Deploying assistive devices such as blind canes as appropriate.

7.1 Hematoma/laceration of external ear

No special treatment is generally required after healing.

7.2 External ear defect

The follow-up diagnosis and treatment items are as follows.

a) Replantation or reconstruction is feasible when necessary;

b) False ears can be configured as appropriate.

7.3 Traumatic tympanic membrane perforation

Most can heal by themselves; those who cannot heal themselves after 6 weeks can be repaired by surgery.

7.4 Auditory bone injury

Middle ear exploration can be performed to repair the ossicular chain. If postoperative complications such as adhesions and ossicular dislocation/dislocation are possible, surgery can be performed again.

7.5 Hearing and hearing impairment

The follow-up diagnosis and treatment items are as follows.

a) surgical treatment according to clinical conditions;

b) If necessary, mobile assistive devices such as hearing aids and walking sticks can be provided.

7.6 Nasal bone/sinus fracture/nasal septum injury

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing;

b) if the abnormal healing affects function or appearance, feasible surgery can be performed;

c) Patients with deviated nasal septum can be corrected by surgery.

7.7 Nasal defect

The follow-up diagnosis and treatment items are as follows.

a) Feasible repair and plastic surgery;

b) Configure false noses as appropriate.

7.8 Open Laryngeal Injury

The follow-up diagnosis and treatment items are as follows.

a) Feasible laryngomy to repair laryngeal cartilage and laryngeal mucosa;

b) In order to avoid the occurrence of stenosis of the throat, a laryngeal mold is required.

7.9 Thyroid/parathyroid injury

Patients with dysfunction due to glandular injury should be given drug replacement therapy as needed, and if necessary take long-term medication.

7.10 Facial lacerations

The follow-up diagnosis and treatment items are as follows.

a) Perform free skin graft or flap repair if necessary;

b) Relevant plastic surgery should be carried out in two stages as appropriate.

7.11 Lip damage

No special treatment is generally required after healing; in severe cases, repair is performed after the scar has softened.

7.12 Tooth Damage/Defects

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing of minor injuries;

b) Dental crown fracture, root fracture, and defect can be treated with dental implantation,, and restoration.

c) Place dentures as appropriate.

7.13 Sacrum/Sacral Arch Fracture

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing;

b) If the deformity heals/affects the appearance, feasible surgical treatment is available.

8.1 Chest wall contusion/abrasions

No special treatment is generally required after healing.

8.2 Avulsion of chest wall

The follow-up diagnosis and treatment items are as follows.

a) In small areas, no special treatment is generally required after healing;

b) Severe cases are determined based on clinical conditions and clinical evaluation opinions.

8.3 Sternal/Rib Fractures

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after fracture healing;

b) Internal fixation surgery for open fractures of sternum and ribs may be performed by secondary fixation

c) For internal fixation surgery for multiple rib fractures, a second internal fixation operation is feasible;

d) Special circumstances shall be determined according to clinical situation and clinical evaluation opinions.

8.4 Pneumothorax

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing;

b) Special circumstances shall be determined according to the clinical situation and clinical evaluation opinions.

8.5 Heart injury

The follow-up diagnosis and treatment items are as follows.

a) No special treatment is generally required after the wound has healed;

b) Special circumstances shall be determined according to the clinical situation and clinical evaluation opinions.

9.1 Closed abdominal wall injury/open abdominal wall injury

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing;

b) Those without visceral injuries generally do not need special treatment;

c) If secondary hernia is required for secondary surgery, the original scar tissue is removed for repair.

9.2 Liver injury

The follow-up diagnosis and treatment items are as follows.

a) Liver injury caused liver abscess, abdominal abscess, biliary tract bleeding, and bile fistula need to be treated again;

b) Special circumstances shall be determined according to the clinical situation and clinical evaluation opinions.

9.3 Gallbladder and common bile duct injury

The follow-up diagnosis and treatment items are as follows.

a) Patients with gallbladder and common bile duct injury who cannot repair or cause bile fistula in the first stage of surgery need to undergo secondary surgery;

b) Special circumstances shall be determined according to the clinical situation and clinical evaluation opinions.

9.4 Spleen Injury

The follow-up diagnosis and treatment items are as follows.

a) Generally no special treatment is required after healing;

b) the special circumstances are determined according to the clinical situation and clinical evaluation opinions;

c) After pediatric splenectomy, patients with fulminant infection can be determined according to the clinical situation and clinical evaluation opinions.

9.5 Pancreatic Injury

The follow-up diagnosis and treatment items are as follows.

a) If pancreatic fistula fails to heal, consider surgery again;

b) Special circumstances shall be determined according to the clinical situation and clinical evaluation opinions.

9.6 Intestinal injury

The follow-up diagnosis and treatment items are as follows.

a) Duodenal injury caused by duodenal fistula or stenosis, obstruction can be treated with secondary surgery;

b) Intestinal fistula, anastomotic fistula, and anastomotic stenosis caused by small intestinal injury may be treated with secondary surgery;

c) colonic fistula, stenosis and obstruction caused by colon injury can be treated with secondary surgery;

d) Postoperative colostomy or external bowel surgery can be treated with secondary surgery;

e) those who cause rectal fistula, stenosis and obstruction can be treated by surgery;

f) Special circumstances are determined according to the clinical situation and clinical evaluation opinions.

9.7 Kidney/Adrenal Injury

The follow-up diagnosis and treatment items are as follows.

a) Pseudorenal cysts and perrenal abscesses caused by renal injury require surgical incision and drainage;

b) those with renal hypertension need intervention or surgery;

c) feasible drug replacement therapy for patients with endocrine dysfunction;

d) Special circumstances shall be determined according to clinical situation and clinical evaluation opinions.

9.8 Bladder Injury

The follow-up diagnosis and treatment items are as follows.

a) Bladder injury caused by bladder vaginal fistula or bladder rectal fistula requires reoperation;

b) Special circumstances shall be determined according to the clinical situation and clinical evaluation opinions.

9.9 Urethral Injury

The follow-up diagnosis and treatment items are as follows.

a) Patients with urethral stricture caused by urethral stricture need regular urethral dilatation treatment;

b) those with residual urethral fistula need to undergo another surgical treatment;

c) Special circumstances are determined according to the clinical situation and clinical evaluation opinions.

9.10 Scrotal Injury

Determined based on clinical situation and clinical evaluation opinions.

9.11 Penile Injury

The follow-up diagnosis and treatment items are as follows.

a) Partial penile defect (the remaining part is more than 3cm), which can meet the basic urination and sexual function, without the need for surgery

b) Most or all of the penis is defective, urination, male dysfunction, and penile reconstruction surgery as appropriate;

c) Determined according to the clinical situation and clinical evaluation opinions.

9.12 Injury to the vulva and vagina

The follow-up diagnosis and treatment items are as follows.

a) Those with residual vaginal stenosis should undergo surgical treatment according to clinical conditions;

b) those with residual vaginal fistula need to undergo secondary surgery;

c) Determined according to the clinical situation and clinical evaluation opinions.

9.13 Uterus/Accessory Damage

The follow-up diagnosis and treatment items are as follows.

a) No special treatment is usually required after healing (uterine/accessory repair);

b) Patients with endocrine dysfunction should receive drug replacement therapy.

9.14 Intestinal adhesions and intestinal obstruction

The follow-up diagnosis and treatment items are as follows.

a) Adhesion release treatment if necessary;

b) Determined according to the clinical situation and clinical evaluation opinions.

10.1 Fracture of the clavicle/scapula/upper limb long bone

The follow-up diagnosis and treatment items are as follows.

a) For internal fixation treatment, removal of internal fixation is feasible;

b) For fracture nonunion, open reduction and internal fixation and bone grafting can be performed;

c) those with nerve damage and no signs of recovery after conservative treatment for more than 3 months, feasible surgical treatment;

d) rehabilitation training of the affected limb may be considered after the second operation;

e) Equipped with appropriate auxiliary equipment if necessary.

10.2 Acromioclavicular Joint Dislocation

For patients with old acromioclavicular joint dislocations, such as shoulder pain and degenerative changes in the acromioclavicular joint, external clavicle excision can be treated.

Femoral rehabilitation training is available after surgery.

10.3 Humeral intercondylar fractures/Humeral epicondylar fractures/Uraculus fractures

The follow-up diagnosis and treatment items are as follows.

a) For internal fixation treatment, removal of internal fixation is feasible;

b) For fracture nonunion, open reduction and internal fixation and bone grafting can be performed;

c) those with nerve damage and no signs of recovery after conservative treatment for more than 3 months, feasible surgical treatment;

d) For those with severe elbow dysfunction, elbow replacement can be performed if necessary;

e) Feasible limb rehabilitation training after second operation;

f) Equipped with appropriate auxiliary equipment if necessary.

10.4 Dislocation of wrist and palm joint

The follow-up diagnosis and treatment items are as follows.

a) For patients with old wrist and palm joint dislocations, if the symptoms and dysfunctions are not obvious, they can be disregarded. If necessary, open reduction and internal fixation are possible

b) Articular cartilage destruction may be joint fusion, and rehabilitation of the affected limb may be considered after the second operation.

10.5 Metacarpal Fracture/Finger Fracture/Wrist Fracture

The follow-up diagnosis and treatment items are as follows.

a) For internal fixation treatment, removal of internal fixation is feasible;

b) If the fracture does not heal, a second surgical treatment is feasible;

c) Orthotics can be provided if necessary.

10.6 Acetabular Fracture/Femoral Neck Fracture

The follow-up diagnosis and treatment items are as follows.

a) For internal fixation treatment, rem...