Medicolegal evaluation of pediatric patients with injection neuropathy

Injection neuropathy (IN) is a rare but preventable form of iatrogenic nerve injury, particularly affecting the sciatic nerve when intramuscular injections are administered incorrectly. While IN is uncommon in high-income countries, it remains a significant public health issue in Türkiye, especially in pediatric populations. The aim of this study is to evaluate pediatric IN cases referred to the Council of Forensic Medicine and highlight medicolegal aspects to inform clinical and legal preventive strategies.

We retrospectively analyzed 67 pediatric cases (age range: 1-17 years; mean age: 10.5 years; 57 boys, 10 girls) referred to the Council of Forensic Medicine between January 01/01/2015 and January 01/01/2023, due to suspected injection-related sciatic neuropathy. Demographic data, clinical findings, suspected drugs, injection sites, and medicolegal conclusions were reviewed using descriptive statistics.

Sciatic nerve involvement was confirmed in 64 cases. The most frequently implicated drug was diclofenac sodium (n = 38), followed by sulbactam-ampicillin and clindamycin. In 59 cases, complications were identified; 2 cases were classified as malpractice due to incorrect site or technique. Six cases could not be evaluated due to insufficient medical documentation.

Intramuscular injections, especially in pediatric patients, should not be considered routine procedures. Given the potential for severe complications, oral alternatives should be prioritized. When unavoidable, injections must be performed by qualified professionals considering patient age, muscle mass, and anatomical safety. This study underscores the medicolegal importance of accurate technique and documentation to prevent lifelong disability and litigation.