Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 1 - Jan/Mar - 2018

Original Article Imprimir 

Páginas 18 a 25


Injuries in teens victims of physical violence: cases auditedat the Legal Medical Institute

Lesiones corporales en adolescentes víctimas de violencia física: casos peritados en el Instituto Médico Legal

Lesões corporais em adolescentes vítimas de violência física: casos periciados no Instituto Médico Legal

Autores: Mona Lisa Cordeiro Asselta da Silva1; Maria Conceição Oliveira Costa2; Jamilly de Oliveira Musse3; André Henrique do Vale de Almeida4; Celso Danilo Fonseca Vilas Boas5

1. Mestre em Saúde Coletiva pelo Programa de Pós-Graduação em Saúde Coletiva da Universidade Estadual de Feira de Santana (UEFS). Doutoranda em Saúde Coletiva pela UEFS. Feira de Santana, BA, Brasil. Feira de Santana, BA, Brasil
2. Post-doctorate from Université du Québec to Montreal (UQAM). Montréal, Canada. Doctorate in Medicine and Applied Sciences in Pediatrics at the Federal University of São Paulo (UNIFESP). São Paulo, SP, Brazil
3. Doctorate in Dental Sciences from the University of São Paulo (USP). São Paulo, SP, Brazil. Professor at the State University of Feira de Santana (UEFS). Expert of the Technical Police Department of Bahia (DPT / BA). Feira de Santana, BA, Brazil
4. Doctor in Epidemiology in Public Health by the Oswaldo Cruz Foundation. Master in Public Health by the Postgraduate Program in Public Health. Professor at the Feira de Santana State University (UEFS). Feira de Santana, BA, Brazil
5. Specialist. Expert of the Technical Police Department of Bahia (DPT / BA). Feira de Santana, BA, Brazil

Correspondência:
Mona Lisa Cordeiro Asselta da Silva
Universidade Estadual de Feira de Santana
Avenida Transnordestina, s/n, Novo Horizonte
Feira de Santana, BA, Brasil. CEP: 44036-900
(mona.cordeiro@hotmail.com)

PDF Portuguese      


Scielo

Medline


How to cite this article

Keywords: Wounds and injuries, facial injuries, violence, domestic violence, adolescent.
Palabra Clave: Heridas y lesiones, traumatismos faciales, violencia, violencia doméstica, adolescente.
Descritores: Ferimentos e lesões, traumatismos faciais, violência, violência doméstica, adolescente.

Abstract:
OBJECTIVE: The present research had the objective to characterize injuries, according to type and location, in adolescents victims of physical violence at the Instituto Médico Legal - IML de Feira de Santana-Ba.
METHODS: Study of a series of cases with adolescents victims of physical violence, submitted to the examination of physical injury, performed by IML experts, from January 01 to December 31, 2014. A bivariate analysis was performed between head and neck trauma, characteristics of the lesions, of the victims and their aggressors, using Pearson's Chi-square (χ2) with p ≤ 0.05, and a 95% confidence interval.
RESULTS: The proportion of cases between males and females were similar in the 343 victims examined (51.6% and 48.4, respectively); 91% had brown skin color (faioderma); 38.2% were affected in the head and 30.8% in the upper limbs; The majority of lesions were trauma (79.2%), bruises (44.2%), ecchymoses and edema (47%). Bivariate analyzes showed similar proportions of head and neck injuries in both sexes (54.7% and 50%), and the aggressors were majorly familiar (61.1%), with household occurrences (57.5%), presenting two or more body injurie, caused by blunt instrument (45,1).
CONCLUSION: The findings of the IML's experts examination contribute to the indicators that shows the need for preventive actions against household and extra-household adolescents victimization.

Resumen:
OBJETIVO: La presente pesquisa tuvo como objetivo caracterizar lesiones corporales, según el tipo y localización, en adolescentes víctimas de violencia física peritados en el Instituto Médico Legal - IML de Feira de Santana-Ba.
MÉTODOS: Estudio de serie de casos con adolescentes víctimas de violencia física sometidos al examen de lesión corporal, ejecutado por peritos del IML, en el periodo 01 de enero al 31 de diciembre de 2014. Fue realizado análisis bivariado entre trauma de cabeza e cuello, características de las lesiones de las víctimas y sus respectivos agresores, utilizándose Cui-cuadrado (χ2) de Pearson con p ≤ 0,05, e intervalo de confianza de 95%.
RESULTADOS: Las proporciones de casos entre hombres y mujeres fueron semejantes en las 343 víctimas examinadas (51,6% y 48,4 respectivamente); 91% eran de color pardo (faioderma); 38,2% fueron alcanzados en la cabeza y 30,8% en miembros superiores; la mayoría de las lesiones era contusa (79,2%), de tipo escoriaciones (44,2%), equimosis y edemas (47%). Los análisis bivariados mostraron proporciones semejantes de lesiones en cabeza y cuello, en ambos sexos (54,7% y 50%), siendo la mayor parte de los agresores familiares (61,1%), con ocurrencias domiciliarias (57,5%), presentando dos o más lesiones corporales causadas por instrumento contundente (45,1).
CONCLUSIÓN: Los hallazgos del examen pericial de lesiones corporales del IML contribuyen con el estudio de indicadores que apuntan a la necesidad de acciones de prevención frente a la victimización domiciliaria y extra domiciliaria de adolescentes.


Resumo:
OBJETIVO: A presente pesquisa teve como objetivo caracterizar lesões corporais, segundo tipo e localização, em adolescentes vítimas de violência física periciadas no Instituto Médico Legal - IML de Feira de Santana-Ba.
MÉTODOS: Estudo de série de casos com adolescentes vítimas de violência física submetidos ao exame de lesão corporal, executado por peritos do IML, no período 01 de janeiro a 31 de dezembro de 2014. Foi realizada análise bivariada entre trauma de cabeça e pescoço, características das lesões das vítimas e seus respectivos agressores, utilizando-se Qui-quadrado (χ2) de Pearson com p ≤ 0,05, e intervalo de confiança 95%.
RESULTADOS: As proporções de casos entre homens e mulheres foram semelhantes nas 343 vítimas examinadas (51,6% e 48,4 respectivamente); 91% eram de cor parda (faioderma); 38,2% foram atingidos na cabeça e 30,8% em membros superiores; a maioria das lesões era contusa (79,2%), do tipo escoriações (44,2%), equimoses e edemas (47%). As análises bivariadas mostraram proporções semelhantes de lesões em cabeça e pescoço, em ambos os sexos (54,7% e 50%), sendo a maior parte dos agressores familiares (61,1%), com ocorrências domiciliares (57,5%), apresentando duas ou mais lesões corporais causadas por instrumento contundente (45,1).
CONCLUSÃO: Os achados do exame pericial de lesões corporais do IML contribuem com o levantamento de indicadores que apontam a necessidade de ações preventivas frente à vitimização domiciliar e extradomiciliar de adolescentes.

INTRODUCTION

At present, body injuries resulting from falls, traffic accidents and various forms of physical violence are among the main causes of mortality among young people, where head and neck trauma present the highest prevalence1. The cause of facial trauma is heterogeneous and the predominance of an etiological factor depends on the characteristics of the victim (sex, age, social class, place of occurrence, among other attributes), as well as factors related to the context and involvement of other subjects2.

Different studies indicate that most of the injuries that have like a etiological factor physical violence in adolescents involve the head, face, mouth and neck regions, areas that are notoriously less protected1. Another factor of greater aggravation is associated with the position of the aggressor towards the victim, since, generally, these are higher and stronger. However, other parts of the body are susceptible to accidental injuries, such as the thigh, genitals, costal back, among others. It is worth noting that the location of the lesions can also be an important indication of the occurrence or not of physical violence3.

Violence has a different expression, but physical violence is the easiest to diagnose, since marks on the victim's body are easily visualized. Physical abuse can be characterized by a single or repeated, intentional, non-accidental action performed by parents, caregivers, relatives or close associates, resulting in an extensive variability of injuries, with different risks4.

Violence against adolescents, and their consequences, affect their quality of life and contribute to the perpetuation of the phenomenon. Aggression, regardless of origin, will have an impact throughout life, presenting specific characteristics in its behavior and also in the physical aspect of the body5. Victims of physical violence generally have personal injuries that are defined by the Brazilian Penal Code6 in its article 129 as "offense to the physical integrity or the health of others," having as punishment the detention, from three months to a year, and may vary according to the severity of the injury.

Also regarding the characteristics of the lesions, the soft tissue is the most affected and the cutaneous-mucosal lesions caused by ill-treatment may result from blows, throwing against hard objects, burns, "pulls", bites, or firearm. These lesions may present hyperemia, excoriations, bruises and bruises, to third-degree burns, where bruises are the most frequent skin lesions in physical abuse, followed by lacerations and scratches7.

In relation to the instrument used to cause the lesion, the identification can be verified by the "printed" shape on the skin (belts, yarns, forks, cigarettes, teeth), and it is fundamental that the evaluation of these lesions is performed with technical details, considering the size , the edges, the location and the color of the edges7.

The medical and dental experts present at the Medical Legal Institutes (IMLs) are the professionals responsible for carrying out the physical injury examination and its respective report, which requires that they be requested by a competent body (for example, judicial or police officer). Following the production of the report by the experts, the experts are sent to the requesting body and they are responsible for appending to the processes. The Judge will not be restricted to the award, being able to reject it in its totality or parts.

The objective of this study was to characterize body injuries, according to the type and location, in adolescents victimized by physical violence, interviewed at the IML of Feira de Santana, regional headquarters of the Recôncavo da Bahia.


METHOD

A case study of predominantly descriptive character on the characteristics of corporal injuries suffered by adolescents (12-18 years old) victims of physical violence, submitted to physical injury examination, performed by medical-legal and / or dental-legal experts in the IML of Feira de Santana-Ba, in the period from January 1, 2014 to December 31, 2014.

Bivariate analyzes were performed to evaluate possible association between victim characteristics, aggression and injury with trauma in the head and neck region. Pearson's Chi-square (χ2) was used for the associations with p value ≤ 0.05, and a 95% confidence interval.

The study was approved by the Human Research Ethics Committee (CEP) of the Feira de Santana State University/UEFS (CAAE 46251015.2.0000.0053).


RESULTS

In 2014, 343 adolescents victims of physical violence were examined by the medical experts and dentists of the IML of Feira de Santana. The results (Table 1) showed similar proportions of violence for both genders, 51.6% male and 48.4% female; 66.3% were attending the fundamental level; 69.1% were from Feira de Santana and 91% were classified as brown (skin color faioderma).




According to the results of Table 2, it was verified that 46.2% had two or more body lesions; the regions most affected were head (38.2%) and upper limbs (30.8%); the bruise represented 79.2% of the cases, with bruising being the most frequent type of contusion (44.2%), followed by ecchymosis and traumatic edema (470%).




Table 3 shows the results of bivariate analyzes of the associations between trauma in the head and neck region and the characteristics of the victim, the aggression and the injury. These results were proportional between male (54.7%) and female (50.0%); the majority of the perpetrators were familiar (61.1%), with a home occurrence (57.5%). Most of the adolescents had one (57.3%), two or more (51.3%) body injuries, caused by a blunt instrument (45.1%) and other types (52.3%).




DISCUSSION

The expert assessment of body injury at the Feira de Santana IML found that adolescents of both sexes were victims of similar proportions, with a slight predominance of male perpetrations, in relation to the female, but without significant difference between the sexes, corroborating with findings in another study8. However, other studies verified a higher proportion of female victims (60% and 70%), respectively10,11,12. It should be noted that, in these studies, there were also no significant differences in victimization between the sexes. Scholars say that physical violence perpetrated in adolescents affects boys and girls, although in the group above 18 years these results change, with a predominance of male victimization.

Regarding the ethnic aspects, the literature is consensual regarding the higher frequency of victimization between brown and black individuals, regardless of gender and region of origin. In Feira de Santana, the present result corroborates Silva et al. (2013)9 who verified the brown color in 51.6% of victims, as well as Pimenta et al. (2013)13, with 64.2% and Guimarães and Vilella (2011)12 (71.6%).

In the present study, the schooling findings confirm other studies that observed victims attending school age-appropriate series, as recommended by the MEC, suggesting that the level of schooling seems to have had no relation to the violent episode. A study carried out in Recife also found a high proportion of adolescents attending elementary school incomplete, of both sexes9

Regarding the origin of the victims, Feira de Santana was the municipality with the highest number of records. It´s noteworthy that this municipality is a reference in the region of the state's concave and receives a high flow of migration, considered a portal of the semi-arid region of Bahia, nationally recognized by the high rates of child and youth violence. The determinants related to these indices may be related to geographic, structural and social factors, such as: being located on the margins of the major road junction connecting the north-northeast-southeast regions of the country, surrounded by several Federal and State highways, intense migratory flow of vehicles and people, just 100 km from Salvador, an important industrial and tourism hub at the national level14.

Regarding the lesions detected, at the moment of the investigation, 46.2% of the victims presented ≥ 2 lesions. Cavalcanti (2008)15 observed that 66.7% of the victims had only one lesion and 21.4% had two lesions. As a possible explanation it is known that, in general, aggressors of children and adolescents use physical force with the purpose of punishing or correcting some act of "indiscipline" and not with the intention of causing serious injuries, even though they may precipitate damages to health physical and mental. Thus, the number of injuries can result from factors related to the aggressors' attitudes, and the interference of third parties, preventing the execution of further blows and even the victim's reaction in an attempt to protect himself.

As for the body segment, the head was the most affected, besides the upper limbs, results that corroborate with the studies of Martins and Andrade (2005)16 and Garbin et al. (2006)17, where it was observed that 34.9% and 30% of the victims were affected in the head and neck region, followed by the upper limbs, 24.3% and 24.4%, in the respective studies. Head and neck aggressions are more frequent, possibly because they are more prominent anatomical areas or the position of the aggressor in relation to the victim. In the upper limbs, usually the so-called "defense injuries" are those that are produced at the time of the victim's movement to defend himself against the aggressor.

In the present study, the contusional lesion was the most prevalent (79.2%), corroborating with the study by Garbin et al. (2006)17 who found 60% of the victims suffering from injuries caused by blunt instruments. Similarly, the study by Pimenta et al. (2013)13 in the IML of Feira de Santana observed that 96.5% of the instruments used to provoke the lesions were also conclusive.

Still considering the lesions, the findings of the present study indicated that bruises were the most frequent contusions, followed by ecchymoses and traumatic edema, in agreement with the findings of Cavalcanti (2008)15 who found a high prevalence of abrasions in 62% of cases, as well as with the results of Pimenta et al. (2013) 13 who found a higher frequency of edema (43.8%) and ecchymosis (19.7%). It should be noted that abrasions are the most frequent lesions when compared to other types of blunt injuries, as they don´t require a very great force or impact, a simple touch can cause injury, depending on the instrument used to attack the victim.

The analyzes between the most affected body segment (head and neck region) and characteristics of victims, aggressors and lesions, didn´t show statistical significance. However, the high frequency of relatives in the condition of aggressor and most of the occurrences occurring in the adolescent's home is highlighted, although more than 50% of the cases had a non-familial aggressor and extra-domicile occurrence. These results agree with other studies that indicate a high frequency of known aggressors, as well as of cases victimized by relatives and extra-domiciliary occurrences8,12,14,18,19,20.

Also with respect to head and neck injuries, studies show that blunt instruments are easier to use, such as using hands (through punches and punches), as well as using feet (kicks and kicks), which explains a greater frequency of blunt injuries. In the present study, the results indicated that the most frequently used instrument was aggressive type (45.1%); however, in the case of the head and neck region, other types were used.


CONCLUSION

The IML results from the Feira de Santana region indicated that adolescents of both sexes were victims, with a slight predominance of boys, even when head and neck injuries were analyzed. Most had two or more blunt injuries, such as bruises, bruises, and traumatic edema, with a family member and home occurrence as the most frequent offender. The findings of this study contribute to deepening knowledge about the consequences of physical violence perpetrated in adolescents, with the participation of the family and social environment known as agents of violence.

Likewise, these results can support the implementation of strategic protection and prevention actions for adolescents victims of violence, in the context of the family and in the wider social environment. The family has a fundamental role in the formation of adolescents and the social environment, represented by multiple segments and institutions. It also highlights the role of the school among the reference groups in the formation and preparation of the young person for the future exercise of full citizenship. Both the family and the school must consider their rights and duties vis-à-vis adolescents, where adults are given the experience, as well as the identification and formation links of the new generations.

In this sense, there is a need for greater investment in preventive educational actions, as well as policies aimed at social inclusion, combating exclusion, as well as greater adequacy of the system of notification and denunciation involving the "Network" for coping with violence, Health and Public Safety System.


REFERENCES

1. Carvalho TBO, CancianL RL, Marques CG, Piatto VB, Maniglia JV, Molina FD. Six years of facial trauma care: an epidemiological analysis of 355 cases. Braz J Otorhinolaryngol 2010 set/out;565-74.

2. Montovani J C, Campos LMP, Gomes M A, Moraes V R S, Ferreira F D Nogueira E A. Etiologia e incidência das fraturas faciais em adultos e crianças: experiência em 513 casos. Rev Bras Otorrinolaringol 2006 mar/abr: 235-41.

3. França GV. Medicina legal. 8ª. ed. Rio de Janeiro: Guanabara Koogan, 2008.

4. Brasil. Ministério da Saúde. Secretaria de Políticas de Saúde. Violência intrafamiliar: orientações para prática em serviço / Secretaria de Políticas de Saúde. Brasília: Ministério da Saúde, p. 96, 2001.

5. Pires GE, Gomes EM, Duarte AD Macedo AF. Violência interpessoal em vulneráveis e mulheres: perfil das vítimas e diagnóstico pericial das lesões maxilomandibulares. Oral Sciences2012 jan/jun; 4(1):10-17,.

6. Brasil. Decreto-Lei 2.848, de 07 de dezembro de 1940. Código Penal. Diário Oficial da União, Rio de Janeiro, 31 dez. 1940.

7. Cavalcanti AL, Valença AMG, Duarte RCO. Odontopediatra diante de maus tratos infantis: diagnóstico e conduta. J Bras Odontoped Odont Bebê 2000nov/dez;3(16):451-455.

8. Souza CS, Costa MCO, Assis SG, Musse J O, Sobrinho CN Amaral MTR. Sistema de Vigilância de Violências e Acidentes/VIVA e a notificação da violência infanto-juvenil, no Sistema Único de Saúde/SUS de Feira de Santana-Bahia, Brasil. Ciência & Saúde Coletiva 2014;19(3): 773-784.

9. Silva MCM, Brito AM, Araújo AL, Abath MB. Caracterização dos casos de violência física, psicológica, sexual e negligências notificados em Recife, Pernambuco. Epidemiol Serv Saúde 2013jul/set;  22(3): 403-412.

10. Brito AMM, Zanetta DMT, Mendonça RCV, Barison SZP, Andrade VAG. Violência doméstica contra crianças e adolescentes: estudo de um programa de intervenção. Ciência & Saúde Coletiva 2005; 10(1): 143-149.

11. Vieira D, Martins CS, Ferriani MGC, Nascimento LC. Caracterização da violência física contra crianças e adolescentes. Revista de Enfermagem 2004;12(3): 306-311.

12. Guimarães JATL, Vilella WV. Características da violência física e sexual contra crianças e adolescentes atendidos no IML de Maceió, Alagoas, Brasil. Caderno de Saúde Pública 2011;27(8): 1617-1647.

13. Pimenta RMC, Matos FRRO, Silva M LCA, Rodrigues AAAO, Marques JAM, Musse JO. Levantamento de lesões na região bucomaxilofacial em vítimas de violência periciadas no Instituto Médico Legal (IML) de Feira de Santana-BA, entre 2007 e 2009. Arquivos em Odontologia 2013;49(4):154-161.

14. Paixão F, Santana G, Sá J, Reis S, Conceição E. Análise espacial da violência urbana no município de Feira de Santana - Bahia. Disponível em: <www.nipes.feiradesantana.ba.gov.br/download/pesqmandioca.doc>. Acesso em: 06 de março de 2016.

15. Cavalcanti AL. Lesões no complexo maxilofacial em vítimas de violência no ambiente escolar. Ciência & Saúde Coletiva 2008; 4(5): 1835-1842.

16. Martins CBG, Andrade SM. Causas externas entre menores de 15 anos em cidade do Sul do Brasil: atendimentos em pronto socorro, internações e óbitos. Revista Brasileira de Epidemiologia 2005; 8(2): 194-204.

17. Garbin CAS, Garbin AJI, Dossi AP, Dossi MO. Violência doméstica: análise das lesões em mulheres. Caderno de Saúde Pública 2006 dez; 22(12):2567-2573.

18. Cavalcanti AL, Assis KM, Cavalcante JR, Xavier AFC, Aguiar YPC. Traumatismos Maxilofaciais em Crianças e Adolescentes em Campina Grande, Paraíba, Brasil. Pesquisa Brasileira de Odontopediatria Clinica Integrada 2012;12(3):439-445.

19. Gomes MLM, NetoGHF, VianaCH, Silva MA. Perfil clínico-epidemiológico de crianças e adolescentes do sexo feminino vítimas de violência atendidas em um Serviço de Apoio à Mulher, Recife, Pernambuco. Rev. Bras. Saúde Matern. Infant 2006 maio;6(1): 27-34.

20. Pascolat G, Santos CFL, Campos ECR, Valdez LCO, Busato D, Marinho DH. Abuso físico: o perfil do agressor e da criança vitimizada. Jornal de Pediatria 2001;77(1):35- 40.
adolescencia adolescencia adolescencia
GN1 © 2004-2018 Revista Adolescência e Saúde. Fone: (21) 2868-8456 / 2868-8457
Núcleo de Estudos da Saúde do Adolescente - NESA - UERJ
Boulevard 28 de Setembro, 109 - Fundos - Pavilhão Floriano Stoffel - Vila Isabel, Rio de Janeiro, RJ.
E-mail: revista@adolescenciaesaude.com