Türkiye’de Çocuk ve Ergen Adli Olgularında Hastane Dışı Ölüm Belgelendirmesinin Belirleyicileri: Retrospektif Bir Çalışma

Aim: The distinction between in-hospital and out-of-hospital death certification carries important forensic and epidemiologic implications. While many studies have examined clinical outcomes of pediatric deaths, few have investigated the demographic, circumstantial, and cause-specific predictors of out-of-hospital certification in forensic practice. Methods: We conducted a retrospective analysis of 2,214 pediatric and adolescent forensic cases recorded between 2019-2023. Variables included cause of death, sex, nationality, age at death, place of incident, and season. Causes of death were grouped as intentional injuries, unintentional injuries, medical or procedural causes, and other or undetermined. Place of death was dichotomized into in-facility/ambulance and out-of-hospital. Descriptive analyses, chi-square test, nonparametric comparisons, and multivariable logistic regression were applied. Results: Overall, 17.9% of cases were certified out of hospital. Out-of-hospital certification was significantly more likely for unintentional injuries (OR=1.97, 95% CI: 1.45-2.67), intentional injuries (OR=1.96, 95% CI: 1.15-3.35), and other or undetermined causes (OR=26.89, 95% CI: 18.10-39.97) compared with medical or procedural causes. Foreign nationality (OR=1.90, 95% CI: 1.42-2.54) and increasing age (OR=1.14 per year, 95% CI: 1.12-1.17) were also independent predictors. Seasonal variation showed lower odds in summer relative to winter (OR=0.65, 95% CI: 0.46-0.93). Sex was not associated with place of death. Model diagnostics supported validity, with acceptable collinearity, linearity of the logit for age, and strong overall fit. Conclusions: Out-of-hospital death certification among children and adolescents was strongly associated with external and undetermined causes, older age, and foreign nationality. These findings provide context-specific evidence from Türkiye and suggest that out-of-hospital death certification may reflect differences in case circumstances, access to care, and social vulnerability. Better integration of forensic data with public health surveillance may improve the interpretation of pediatric mortality patterns.