法医学杂志 ›› 2021, Vol. 37 ›› Issue (5): 661-665.DOI: 10.12116/j.issn.1004-5619.2020.101101

• 案例分析 • 上一篇    下一篇

脑震荡后综合征伤残重新鉴定分析

张盛宇(), 李豪喆, 陈琛, 张钦廷()   

  1. 司法鉴定科学研究院 司法部司法鉴定重点实验室 上海市法医学重点实验室 上海市司法鉴定专业技术服务平台,上海 200063
  • 收稿日期:2020-11-09 发布日期:2021-10-25 出版日期:2021-10-28
  • 通讯作者: 张钦廷
  • 作者简介:张钦廷,男,博士,主任法医师,主要从事法医精神病学研究;E-mail:zhangqinting@126.com
    张盛宇(1987—),男,硕士,主检法医师,主要从事法医精神病学研究;E-mail:tmac1zsy@163.com
  • 基金资助:
    国家自然科学基金资助项目(81801881);国家重点研发计划资助项目(2016YFC0800701);中央级公益性科研院所基本科研业务费专项资金资助项目(GY2018G-8);上海市“科技创新行动计划”社会发展科技攻关资助项目(20DZ1200300);司法部司法鉴定重点实验室资助项目;上海市法医学重点实验室资助项目(21DZ2270800);上海市司法鉴定专业技术服务平台资助项目(19DZ2292700)

Analysis of Post-Concussion Syndrome Disability Re-appraisal

Sheng-yu ZHANG(), Hao-zhe LI, Chen CHEN, Qin-ting ZHANG()   

  1. Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
  • Received:2020-11-09 Online:2021-10-25 Published:2021-10-28
  • Contact: Qin-ting ZHANG

摘要: 目的

探讨脑震荡后综合征伤残评定的现状及重新鉴定意见变更的原因。

方法

回顾性分析初鉴意见为“脑震荡后综合征、十级伤残”,并于2019年在司法鉴定科学研究院行精神伤残重新鉴定的案件。

结果

案件合计75例,58例有院前急救病历,其中39例明确记载无昏迷史;74例有急诊病历,其中44例记载有昏迷史;43例有后续医疗记录,其中24例有精神科复诊史。被鉴定人鉴定检查主诉症状有头痛、头晕、夜眠差、烦躁易怒、记忆力减退、疲乏和注意力不集中。重新鉴定申请理由主要有昏迷史认定存疑、精神症状可信度存疑、脑震荡后综合征不构成伤残或对原鉴定程序或原鉴定机构有异议。鉴定意见更改合计47例,其中7例不构成伤残,原因主要为无明确昏迷史记录和承认头部未受伤;其余40例须法院认定昏迷史后方能明确是否构成伤残,原因为昏迷史前后记录不一致或有涂改和添加情况。

结论

既往对脑震荡后综合征伤残评定条件过于宽松,必须进一步规范并从严把握。

关键词: 法医精神病学, 脑震荡后综合征, 精神伤残, 重新鉴定

Abstract: Objective

To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.

Methods

The cases that were judged as “post-concussion syndrome and ten-level disability” in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.

Results

There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn’t meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.

Conclusion

In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.

Key words: forensic psychiatry, post-concussion syndrome, mental disability, re-appriasal

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