Hospital-based clinical forensic medicine for living victims of violence: patterns, pathways and medico-legal implications from a seven-year retrospective study.

Clinical forensic medicine is increasingly involved in the hospital-based assessment of living victims of violence, where early medico-legal consultation may contribute to injury documentation, evidence preservation, safeguarding decisions and referral to dedicated clinical pathways. This retrospective observational study analysed hospital medico-legal consultations requested for bodily injuries and suspected, reported or clinically alleged sexual violence at a tertiary university hospital in Southern Italy from 2019 to 2025. Demographic, clinical, forensic, contextual and organizational variables were extracted from anonymized medico-legal and hospital records. A total of 445 consultations were included: 346 for bodily injuries and 99 for sexual violence. Sexual violence consultations involved younger patients, a higher proportion of females, a higher proportion of minors and more frequent night-shift presentation than bodily injury consultations. In an exploratory complete-case multivariable logistic regression model including 435 consultations, sexual violence consultations remained independently associated with younger age, female sex and night-shift presentation. Bodily injury consultations were mainly related to suspected interpersonal aggression, with blunt force trauma as the most frequent suspected mechanism. In sexual violence consultations, genital injuries were documented in a minority of cases, whereas extra-genital injuries were more frequent. These findings characterize a hospital-based clinical forensic workload involving living victims of violence and highlight the need for timely medico-legal availability, standardized documentation and multidisciplinary coordination. They should be interpreted as consultation-based data rather than as estimates of violence prevalence or evidence of pathway effectiveness.