Terminological Ambiguities in Clinical Injury Reports and Their Impact on Forensic Assessment: A Multidisciplinary, Retrospective, Corpus-Based Study in Hungary

Background/Objectives: Clinical documentation of injuries is essential for forensic evaluation, especially in criminal cases. However, vague descriptions and inconsistent terminology often reduce the forensic utility of these records. This study examines the terminological quality and forensic interpretability of clinical injury documentation with the aim of improving medico-legal assessments. Methods: A corpus of 1000 Hungarian medical diagnostic reports of injuries was analyzed using descriptive statistics and manual terminological review. Results: Significant gaps in morphological detail and frequent terminological inconsistencies were found. Terms describing incised and chop wounds were often used interchangeably or inaccurately, impairing forensic interpretation of injury mechanisms, instruments, severity, and anatomical location. These variations also challenge bodily harm classification and injury event reconstruction. Conclusions: The findings highlight the need for harmonizing clinical and forensic terminology. Improved consistency in injury documentation will enhance its clarity, reliability, and forensic value, facilitating better interdisciplinary collaboration and legal outcomes.