FORMAL AND TECHNICAL-SCIENTIFIC QUALITY PARAMETERS OF JUDICIAL FORENSIC MEDICAL REPORTS: A CRITICAL NARRATIVE REVIEW

1.    INTRODUCTION

Judicial forensic medical reports constitute a central technical element of expert evidence, exerting a decisive influence on the formation of the adjudicating authority’s conviction regarding the existence of incapacity, damage, and causal nexus. National evidence demonstrates that judicial decisions, in a large proportion of cases, are based directly on expert conclusions, conferring high probative weight on the report and imposing on the expert the duty of technical rigor, communicative clarity, and consistent reasoning (1,2).

Despite their central probative role, forensic medical reports remain heterogeneous in form and content and are frequently valued more for their conclusions than for the technical and communicative quality that supports them. Although Resolution No. 2,430/2025 of the Federal Council of Medicine (Conselho Federal de Medicina – CFM) defines the report as a reasoned, impartial, and traceable technical document, national and international studies point to recurrent weaknesses in the structure, clarity, and coherence between findings and conclusions in forensic medical reports (3–7).

In order to mitigate these shortcomings, recent institutional initiatives have sought to qualify forensic practice. Notably, the guidelines of the Brazilian Association of Legal Medicine and Medical Expert Practice (Associação Brasileira de Medicina Legal e Perícias Médicas – ABMLPM) and Resolution No. 595/2024 of the National Council of Justice (Conselho Nacional de Justiça – CNJ) emphasize the harmonization of procedures, the improvement of expert questioning, and the qualification of forensic communication (8,9). Complementarily, resolutions issued by the CFM and the Brazilian Technical Standards Association (Associação Brasileira de Normas Técnicas – ABNT), particularly NBR 10719:2015, establish formal foundations for the preparation of technical documents, reinforcing the need for logical structure, impersonal language, and methodological transparency (10–12).

Nevertheless, proposals that systematically integrate these normative and scientific references into minimal operational quality parameters applicable to forensic practice remain scarce. In response to this gap, the present study proposes the consolidation of formal and technical-scientific quality parameters for judicial forensic medical reports, articulating communicative clarity, procedural traceability, logical coherence, contextualized functional assessment, and evidence-based reasoning (4,6,13–15). The aim is to offer a transversal, verifiable framework applicable to forensic practice, capable of guiding the preparation, supervision, and auditing of expert reports, thereby contributing to the strengthening of the probative value of forensic medical evidence within the judicial system.

2.    MATERIAL AND METHOD

A critical narrative review was conducted, with its scope delimited by official Brazilian regulations and forensic-scientific literature directly related to the preparation, structuring, and quality of judicial forensic medical reports, understood in their formal, technical-scientific, and communicational dimensions.

The normative corpus included resolutions of the Federal Council of Medicine (CFM), notably the Code of Medical Ethics, the regulations governing medical documents, and those concerning the forensic medical act (3,10,11), as well as Resolution No. 595/2024 of the National Council of Justice (CNJ), aimed at standardizing judicial expert examinations, qualifying expert questioning, and improving forensic communication (9). The ABNT NBR 10719:2015 standard on the presentation of technical-scientific reports (12) and the Protocol for the Preparation of Forensic Medical Reports in the Labor Courts, issued by the Brazilian Association of Legal Medicine and Medical Expert Practice (ABMLPM) (8), were also considered.

The scientific literature comprised:

(i) national empirical studies addressing the structure, clarity, and standardization of forensic medical reports (1,4,5);
(ii) critical syntheses and narrative reviews on the probative role and quality of expert reports (7,18);
(iii) international references on best practices in the drafting, reasoning, and communicability of expert reports (6,16); and
(iv) investigations into the perceptions of judges, legal practitioners, and medical experts regarding the usefulness, reliability, and probative value of judicial expert reports (2,17).

The International Classification of Functioning, Disability and Health (ICF) was adopted as a conceptual reference to support the description and interpretation of functioning and capacity, without evaluative or prescriptive intent, with the purpose of qualifying functional analysis in the forensic context (13).

Inclusion criteria encompassed current normative documents and studies directly focused on the formal quality, technical-scientific coherence, and probative robustness of judicial forensic medical reports. Regulations pertaining exclusively to administrative expert practice and publications without direct relevance to the study’s object were excluded.

Data extraction was performed using a standardized analytical matrix covering scope, formal requirements, technical-scientific requirements, quality indicators, and practical applicability. The synthesis of findings was organized into two analytical axes—formal and technical-scientific—through normative and bibliographic triangulation, identifying convergences, gaps, and redundancies among the analyzed references. For terminological precision and appropriate legal-procedural framing, reference was made, when necessary, to Decree No. 3,048/1999 (17).

The methodological choice of a critical narrative review stemmed from the conceptual, normative, and epistemological nature of the subject, which is incompatible with quantitative or meta-analytical synthesis strategies, and proved more suitable for the critical integration of regulations, technical guidelines, and specialized literature.

3.    RESULTS

The normative and bibliographic synthesis made it possible to identify two structuring axes of quality for judicial forensic medical reports—formal and technical-scientific—each composed of essential parameters that translate minimal requirements of consistency, traceability, and probative value of expert evidence.

3.1 FORMAL PARAMETERS (DOCUMENTARY)

Formal parameters refer to the structural, communicational, and organizational aspects of the report, whose observance ensures clarity, verifiability, and logical coherence among the different parts of the forensic document.

3.1.1    COMMUNICATIVE CLARITY

This parameter consists of drafting the report in clear, objective, and technically precise language, while remaining accessible to non-medical procedural actors, avoiding unnecessary jargon, ambiguities, and constructions that hinder the understanding of forensic content (8,10–12). Communicative clarity encompasses not only the vocabulary employed, but also the organization of the text and its internal logic, and the structure of the report should facilitate the immediate understanding of forensic reasoning and the conclusions presented. International studies demonstrate that expository clarity directly influences judicial decision-makers’ comprehension, confidence, and probative use of expert reports (6,16).

3.1.2    COMPLETENESS AND CONCISENESS

This parameter consists of the balanced and sufficient presentation of all information relevant to the object of the expert examination—identification, history, examination, analysis, and conclusions—without omissions that compromise verifiability, but also without excesses that impair clarity. Completeness and conciseness should guide the entire forensic document, ensuring proportionality, technical delimitation, and judicial functionality, particularly in responses to the questions posed (2,4,10).

3.1.3    TECHNICAL-METHODOLOGICAL TRANSPARENCY

This parameter refers to the succinct and verifiable explanation of the logical pathway of the forensic examination, from the delimitation of the object to the conclusion, including the method employed, the analysis performed, and the criteria adopted. The expert and the examinee must be identified in accordance with CFM and CNJ regulations, and relevant clinical and documentary findings, sources used, and technical, methodological, or informational limitations that may influence the scope of the conclusions must be described objectively and strictly within the forensic object (1,3,4,9–11).

3.1.4    INTERNAL COHERENCE

This parameter consists of logical and verifiable correspondence, within the forensic document itself, between the data obtained from the clinical examination, the documents analyzed, and the conclusions presented, avoiding inferences unsupported by recorded evidence. Internal coherence is an essential condition for technical reliability, auditability, and the probative consistency of the forensic medical report (1–3,6,10).

3.2 TECHNICAL-SCIENTIFIC PARAMETERS (FORENSIC CONTENT)

Technical-scientific parameters concern the substantive quality of forensic reasoning, ensuring that the conclusions presented are technically grounded, contextualized, and scientifically sustainable.

3.2.1    CONTEXTUALIZED FUNCTIONAL ASSESSMENT

This parameter consists of describing the examinee’s capacity and limitations in relation to the concrete demands of the activity, function, or act under examination, considering physical, cognitive, and psychosocial aspects in an integrated manner. This assessment should articulate clinical and documentary findings with the practical requirements of the case, allowing functional impact to be inferred in a clear, proportional, and legally relevant manner. The International Classification of Functioning, Disability and Health (ICF) may be used as a conceptual reference, without evaluative or prescriptive intent, contributing to the systematic description of functioning and contextual factors that influence capacity (2,7,13,14).

3.2.2    CAUSAL COHERENCE

This parameter refers to the critical analysis of the plausibility and consistency of the technical nexus between the alleged event and the evaluated condition, considering material and temporal compatibility. Risk factors, relevant exposures, possible concauses, and circumstances capable of influencing the causal relationship should be weighed, with clear explanation of the reasoning adopted, which is an essential condition for the probative solidity of the forensic conclusion (2,3,5,14,17).

3.2.3    EVIDENCE-BASED SCIENTIFIC REASONING

This parameter consists of grounding forensic criteria, methods, and conclusions in up-to-date scientific literature relevant to the object of the examination. The sources used should be explicitly stated in the report, prioritizing clinical guidelines, technical consensus documents, and validated studies. Evidence-based reasoning confers technical-scientific robustness to conclusions, while acknowledgment of the limitations and uncertainties of available knowledge reinforces methodological transparency and the credibility of the forensic medical report (1,7,12,15,18).

4.    DISCUSSION

The quality of the judicial forensic medical report derives from the inseparable integration of form and content. Beyond technical correctness and causal coherence, the formal structure of the document is responsible for ensuring clarity, traceability, and verifiability of forensic reasoning. The normative and bibliographic analysis carried out demonstrates convergence between national and international guidelines in recognizing two complementary axes of quality: the formal axis, oriented toward communication and documentary consistency, and the technical-scientific axis, oriented toward the logical and empirical grounding of forensic conclusions. This distinction, present in different institutional and scientific references (3,6,8,9,11,16), reinforces that form ensures auditability and control, while content sustains technical credibility and the probative value of the report. In light of this understanding, the formal parameters that structure the documentary quality of the judicial forensic medical report are discussed below.

To confer greater conceptual precision to the analysis, operational definitions of the terms traceability, verifiability, and auditability are adopted for the purposes of this study, as presented below.

Traceability: Ensures clear and continuous identification of the logical and informational pathway that leads from the sources examined—clinical data, documents, examinations, reports, and norms—to the analyses performed and the forensic conclusions. A traceable report makes it possible to explicitly recognize which elements support each technical inference, ensuring transparency in the construction of forensic judgment.

Verifiability: Allows a technically qualified third party to confirm, based on the report itself, the correspondence between the recorded data, the procedures adopted, the reasoning developed, and the conclusions presented. A verifiable report makes explicit the relevant clinical, documentary, and methodological elements in sufficient detail to allow the logical sequence of forensic judgment to be checked, without reliance on external or undocumented information.

Auditability: Refers to the property of the report that allows it to be subjected to technical, ethical, and legal control within the judicial process, whether by technical assistants or by the Judiciary itself. An auditable report presents structure, language, and reasoning that make it possible to assess its conformity with professional norms, technical guidelines, and the limits of the forensic object, enabling the identification of flaws, inconsistencies, or extrapolations of the forensic medical act.

4.1 FORMAL PARAMETERS (DOCUMENTARY)

4.1.1    COMMUNICATIVE CLARITY

Communicative clarity constitutes a central attribute of the judicial forensic medical report. It consists of drafting the document in a precise, objective, and comprehensible manner for all procedural actors—judges, attorneys, technical assistants, and parties—while respecting the technical nature of the medical act without compromising its intelligibility in the judicial context.

CFM Resolution No. 2,381/2024 establishes that every medical document must be written objectively, without ambiguities, faithfully reflecting the medical act performed (11). Convergently, CNJ Resolution No. 595/2024 emphasizes the need for accessible technical language and a standardized structure, in order to facilitate judicial understanding and the proper assessment of expert evidence (9).

The literature indicates that lack of clarity is a frequent cause of challenges, requests for clarification, and weakening of the probative value of the report (4,7). It is important to emphasize that communicative clarity is not limited to lexical choices, but also encompasses the logical organization of the document—from initial identification to concluding reasoning—and coherence among its sections. When necessary, the use of medical terminology should be accompanied by succinct functional explanations, avoiding reports that become hermetic or inaccessible to the judicial addressee.

From the perspective of judicial valuation of evidence, Wild highlights that, in forensic practice, expert reports are often primarily assessed based on their conclusions, which makes clarity of the reasoning presented a decisive condition for the proper formation of judicial conviction (2). International studies corroborate this understanding by demonstrating that clear and well-structured expert reports reduce interpretive bias and strengthen judicial confidence in the expert (6,16). Communicative clarity therefore transcends the formal dimension, assuming a relevant role in the ethical and epistemic legitimacy of the forensic medical act.

4.1.2    COMPLETENESS AND CONCISENESS

Completeness and conciseness constitute an essential binomial for the documentary quality of the report. CFM Resolution No. 2,430/2025 defines the forensic medical report as a document that must contain all information necessary for understanding and verifying the expert act, without exceeding the technical scope of the evidence (3). Complementarily, ABNT NBR 10719:2015 recommends that technical-scientific reports be exhaustive regarding essential information while remaining objective and free from redundancies or unnecessary digressions (12).

The empirical analysis conducted by Maeno showed that a significant portion of the labor-related reports evaluated presented relevant informational gaps—especially in the description of examinations and work activities—compromising technical grounding and hindering adequate judicial appraisal (5). Conversely, excessively lengthy reports containing irrelevant or repetitive information tend to impair the overall clarity of the document and communicative efficiency.

Completeness and conciseness should therefore be understood as an expression of proportionality: the report must adequately document the examination, sufficiently respond to the questions posed, and justify its conclusions, without extending into considerations unrelated to the forensic object. This balance reinforces the probative functionality of the document and meets the requirements of efficiency and communicative precision present in CNJ regulations (9) and ABMLPM guidelines (8).

4.1.3    TECHNICAL-METHODOLOGICAL TRANSPARENCY

Technical-methodological transparency refers to the clear, succinct, and verifiable explanation of the logical pathway that underpins forensic reasoning. According to ABNT NBR 10719:2015, technical reports must indicate the methods used, the stages of data acquisition, and the criteria for analysis, enabling understanding and verification of the procedure adopted (12).

In the context of judicial forensic medical practice, this transparency translates into technical traceability, as required by CFM and CNJ regulations (3,9,11), implying the objective description of the clinical, documentary, and contextual elements considered, as well as the technical, methodological, or informational limitations of the examination. Edmond et al. emphasize that scientifically valid forensic reports are those that allow external verification of the reasoning adopted, distinguishing well-founded technical analysis from mere opinion (6).

Beyond conferring scientific reliability, technical-methodological transparency has an important ethical dimension, as it enables technical and legal control of the forensic medical act and protects the expert against arbitrary interpretations or undue extrapolations of their conclusions.

4.1.4    INTERNAL COHERENCE

Internal coherence is the parameter that integrates and consolidates the preceding ones, ensuring logical consistency of the forensic medical report. It consists of direct and verifiable correspondence, within the forensic document itself, among the data obtained from the clinical examination, the documents analyzed, the analysis performed, and the conclusions presented, avoiding contradictions or inferences unsupported by recorded evidence.

CFM Resolution No. 2,381/2024 (11) and the ABMLPM Protocol for the Preparation of Forensic Medical Reports in Labor Courts (8) emphasize the need for correspondence between physical examination, documentation analyzed, and forensic conclusions. Empirical studies indicate that internal inconsistencies are among the main factors leading to loss of credibility of judicial reports, potentially resulting in their disregard or the need for supplementary expert examination (1,4).

Internal coherence thus constitutes a logical and ethical requirement of the forensic medical report, reflecting the intellectual integrity of the expert and the traceability of their technical judgment. It is an indispensable condition for the conclusions presented to be recognized as valid evidence in judicial proceedings.

The formal parameters outlined constitute the documentary and communicative basis of the judicial forensic medical report. However, it is within Axis 2—the technical-scientific axis—that its substantive validity is consolidated, through contextualized functional assessment, causal coherence, and evidence-based scientific reasoning, aspects that will be discussed next.

4.2 TECHNICAL–SCIENTIFIC PARAMETERS (EXPERT CONTENT)

4.2.1    CONTEXTUALIZED FUNCTIONAL ASSESSMENT

Contextualized functional assessment presupposes that the expert evaluation of capacity is not limited to the identification of disease or diagnosis, but rather considers the concrete impact of the assessed condition on the performance of activities related to the expert act. This approach shifts the focus from isolated pathology to functionality, integrating in an articulated manner the observed physical, cognitive, and psychosocial aspects.

In the judicial context, such integration is essential for the expert report to translate clinical findings into legally relevant terms, enabling the judge to understand the functional impact and the practical extent of the alleged limitation. The analysis should be based predominantly on clinical observation, available medical documentation, and coherence between the narrative, the examination, and the activity, function, or act under expert assessment, avoiding conceptual abstractions or formal classifications lacking practical correspondence with the specific case.

The International Classification of Functioning, Disability and Health (ICF) constitutes a useful conceptual framework for describing functioning from a biopsychosocial perspective (13). However, it does not constitute a forensic assessment instrument, as it does not provide objective criteria for grading functional limitation. It should therefore be understood as a conceptual support structure rather than a mandatory technical requirement. Its prudent use, in line with national regulations such as Joint Interministerial Ordinance No. 2/2015 of the Ministry of Social Development and the National Social Security Institute (MDS–INSS), may contribute to greater descriptive clarity and technical-legal certainty, provided that it does not replace the contextualized and individualized clinical analysis performed by the expert (13,15).

Applied forensic medical literature emphasizes that a consistent functional assessment requires direct correlation between clinical findings, activity demands, and the practical repercussions of the limitation; otherwise, conclusions risk becoming generic or disconnected from the concrete case. In conditions such as work-related musculoskeletal disorders, the absence of such functional contextualization compromises the analysis of damage and causation, thereby weakening the expert evidence (14). Thus, the core of a technically sound forensic assessment lies in contextual interpretation and in the clarity with which the expert relates functional limitation to the specific demands of the activity, function, or act under assessment (2,7,8,13).

4.2.2    CAUSAL COHERENCE

The analysis of causal coherence between the assessed condition and the event under expert evaluation constitutes a central stage of judicial medical expertise, as it underpins the establishment of the technical nexus. This analysis requires the integration, at a minimum, of material and temporal elements, considering the plausibility between clinical and documentary findings, the alleged event, and the context in which it occurred.

The expert must examine chronological compatibility between the onset of the condition and the triggering event, the material plausibility of the exposure or injury mechanism, and the presence of contributing causes capable of influencing the outcome. Such an approach allows the distinction between direct, indirect, or merely coincidental causal relationships, ensuring evidentiary objectivity and adequate technical-scientific justification.

The explicit presentation of causal reasoning is particularly relevant in multifactorial conditions, in which the absence of structured analysis frequently leads to challenges, requests for clarification, or misinterpretations. Causal coherence therefore extends beyond mere correspondence between findings and allegations, encompassing the demonstration of a logical and verifiable chain linking the event, the damage, and its functional repercussions—the technical core of the forensic nexus (3,5,6). Reference works in applied forensic medicine highlight that inadequate causal analysis—especially when contributing causes and contextual factors are disregarded—represents one of the main technical weaknesses of judicial expert reports (14,15).

In social security expertise, causal reasoning may consider the technical-epidemiological nexus (NTEP), established by Decree No. 3.048/1999, which sets statistical correlations between certain diseases and occupational activities (17). In the context of labor court proceedings, however, the NTEP has an auxiliary or indicative character and may assist in assessing the plausibility of causation, without replacing the individualized, contextual, and evidentiary technical evaluation of the specific case, as consistently emphasized in specialized forensic literature (14).

4.2.3    EVIDENCE-BASED SCIENTIFIC SUPPORT

Evidence-based scientific support constitutes the structural axis of the technical-scientific quality of the judicial medical expert report. Clinical guidelines, systematic reviews, and validated studies provide an objective basis for the criteria and methods employed, ensuring that conclusions reflect the current state of medical knowledge rather than solely the expert’s individual experience.

The explicit identification of sources used, as well as acknowledgment of limitations or uncertainties inherent to the available knowledge, enhances methodological transparency and the credibility of the expert document (1,7,12). Studies examining the perceptions of legal professionals indicate that reports that clearly present methods and scientific references are perceived as more comprehensible, reproducible, and useful for judicial decision-making (6,16), in line with the parameters proposed herein.

Manuals and works systematizing forensic practice emphasize that scientific grounding should not be confused with bibliographic erudition, but rather with the critical, relevant, and contextualized use of literature aligned with the object of the expertise and presented in a manner intelligible to the judicial recipient (15). Normative initiatives of the National Council of Justice (CNJ) and technical guidelines issued by the Brazilian Association of Legal Medicine and Medical Expertise (ABMLPM) reinforce this understanding, contributing to the consolidation of a national standard of forensic quality based on technical rigor, transparency, and evidentiary usefulness (4,8,12).

Normative analysis complements the technical-scientific framework outlined and reinforces the evidentiary value of the judicial medical expert report, in accordance with the principles of coherence and causation set forth in Decree No. 3.048/1999 (17). Although this narrative review presents limitations inherent to its methodological approach, the findings confirm the practical applicability, internal consistency, and institutional relevance of the proposed parameters within the context of judicial medical expertise.

5.    CONCLUSION

The parameters proposed in this study—formal and technical-scientific—constitute a minimum, structured, and transversal core of quality applicable to the judicial medical expert report. The formal axis encompasses requirements of communicative clarity, completeness and conciseness, technical-methodological transparency, and internal coherence, ensuring intelligibility, traceability, and documentary consistency of forensic reasoning. The technical-scientific axis integrates contextualized functional assessment, causal coherence, and evidence-based scientific support, forming the rational, verifiable, and justifiable basis of expert conclusions.

These parameters arise from the convergence of normative frameworks, medical guidelines, and best forensic practices and do not constitute a rigid or prescriptive protocol, but rather essential quality requirements applicable across different judicial contexts. Their adoption contributes to improving the technical-evidentiary quality of expert reports, strengthening their institutional credibility before the Judiciary without compromising the expert’s technical autonomy and critical judgment.

The incorporation of these parameters into training, supervision, and audit processes of judicial medical expertise may promote qualified standardization and continuous improvement of forensic practice. Further development of objective quality indicators and empirical studies assessing the impact of these guidelines on report reliability, procedural efficiency, and judicial decision-making security is recommended.