Trauma in Health Care Settings: A Twelve-year Medico-legal Case Series and Comparative Analysis of Out-of-court Versus In-court Litigation

BACKGROUND: Falls and traumas in the hospital setting represent one of the main categories of preventable adverse events, with significant clinical, medico-legal, and economic consequences. The phenomenon particularly affects the elderly population and is amplified by demographic aging, patient clinical complexity, and the structural characteristics of health care facilities. MATERIALS AND METHODS: This retrospective study analyses traumatic claims received by the Claims Management Committee of the Policlinico San Martino Hospital in Genoa between 2013 and 2024. All traumatic events occurring within the hospital and related to care or work activities were included. For each case, the event dynamics, type of injury or death, medico-legal process, and amounts paid were analyzed. Extrahospital traumas, nontraumatic claims, and cases lacking adequate documentation were excluded. RESULTS: Out of 1796 total claims, 150 (8.35%) involved traumatic events. Cases showed a predominance of females (70.7%) with a mean age of 64 years. Structural risk was the most frequent (43.3%), followed by clinical risk (34.7%) and occupational risk (22.0%), highlighting the role of environmental hazards. Injuries were mostly fractures (79%), frequently affecting the lower limbs; cranial trauma accounted for the majority of deaths (8%). Seventy-six percent of disputes were resolved extrajudicially, while 20% proceeded to judicial settlement. The total expenditure amounted to €2,447,412.90 (≈$2,820,000), with significantly higher average costs in judicial cases. CONCLUSIONS: Hospital traumatic events have a significant clinical, medico-legal, and economic impact. Integrated preventive strategies and increased extrajudicial management are key elements to reduce traumatic events and related claims.