In the entire study period 1271 of the 3335 persons taken into custody underwent medical consultations, resulting in a frequency of medical consultations of 38.1%. These cases were almost equally distributed, with 635 in the first period (2013–2015) and 636 in the second period (2016–2018). Since a total of 1574 persons were taken into custody in the first period and 1761 persons in the second period, the proportion of cases with necessity of medical consultation decreased from 40.3% to 36.1%.
The majority examined were men 93.9% (n = 1194). The proportion of women showed a slight but not significant increase from the first period (4.9%, n = 31) to the second period (7.2%, n = 46). In terms of age group distribution over the entire period, individuals aged 21–30 years made up the largest proportion (39.3%, n = 499), followed by individuals aged 31–40 years (29.7%, n = 378) and 41–50 years (14.2%, n = 180). The youngest age group (< 20 years) was significantly less likely to be involved (8.6%, n = 109), as were the two oldest groups (51–60 years: 6.5%, n = 83; > 60 years: 1.7%, n = 22). There were no significant differences when comparing the two periods.
In order to classify the indications for medical examination, the criterion was selected which was in the foreground during the assessment (Fig. 1). In about one third of all cases (32.7%, n = 416), it was acute alcohol intoxication, followed by alcohol/drug/medication withdrawal syndromes (14.4%, n = 183). Drug/medication influence (11.8%, n = 150) and trauma (12.0%, n = 152) were almost equal in third place, followed by internal (10.2%, n = 130), non-specific (8.0%, n = 102) and psychiatric (6.5%, n = 82) indications. The proportion of other specific indications (such as epilepsy) was low (4.1%, n = 52) and rare diseases (e.g., narcolepsy, cataplexy, congenital genetic defects) represented just a rarity at 0.3% (n = 4). When comparing the two study periods, alcohol intoxications were significantly more frequent in the first period than in the second (p < 0.001); however, the trend towards a decrease in alcohol withdrawal syndromes from the first to the second period, as shown in Fig. 1, was not quite significant (p = 0.053). In contrast, psychiatric diseases were significantly more frequent in the second period (p = 0.016). The occurrence of the remaining reasons for the medical examinations did not change significantly from the first to the second period.
Averaged over the entire study period, a medical assessment took about 27.2 min, ranging from 5 to 180 min. The average examination time in the first period was 25.0 min, which was shorter than in the second period (29.5 min). Most examinations (88.7%; n = 1128; 575 vs. 553) took place outside regular working hours (weekdays 07:30–16:00), with no noticeable difference between the two periods.
For further statistical evaluation of the duration of the examinations, a multiple regression of the entire dataset was performed. In particular, the aim was to clarify whether there was a correlation between the duration and the time of the examination (first or second period) and whether, independently of this, a migration background of the person examined also had an influence on the duration of the examination. There was no indication of a statistically significant interaction between the time of the examination (first vs. second period) and the presence or absence of a migration background (b = −1.51; SE = 2.112; t = −0.71; p = 0.48). As the presence of a language barrier and a migration background were strongly correlated (Pearson’s product-moment correlation: r = 0.80; p < 0.001; t = 48.15; df = 1269), we decided not to include this as an additional predictor in the model. On average, the duration of an examination of fitness for custody in the first period and without the presence of a migration background was 24.46 min (b = 24.46; SE = 0.67; t = 36.42; p < 0.001). An examination in the second period took on average 4.20 min longer (b = 4.2016, SE = 0.906, t = 4.6, p < 0.001). If the examined person had a migration background, the examination lasted on average 3.55 min longer, regardless of the time of examination (b = 3.5578; SE = 1.0469; t = 3.398; p < 0.001).
Regarding the medical decision after the examination, in 75.4% (n = 958) of all cases in the entire study period (2013–2018) a limited fitness for custody was conducted. In a total of 17.4% of cases (n = 221), unrestricted fitness for custody was determined, while over both periods, approximately equally distributed, lack of fitness for custody was assessed in a total of approximately 7.2% of cases (n = 92). In the first period, unrestricted fitness for custody was confirmed significantly more often (χ2-test, p < 0.001) (Fig. 2). In contrast, limited fitness for custody was certified significantly more often in the second period (χ2-test, p < 0.001).
In the cases with limited fitness for custody, several medical recommendations were often made. The most frequent recommendation (59.9%, n = 761) was to require a new medical examination in the case of a considerable deterioration in condition. In descending order of frequency, 43.8% (n = 557) of cases involved a recommendation of more frequent checks (than specified in the detention order) and in 33.7% (n = 428) the use of a video surveillance in the detention cell (video cell) was suggested. Recommendations on food and fluid intake, at 15.3% (n = 195), and on taking medication, at 11.0% (n = 140), were also relatively frequent. Less frequent were recommendations to see a specialized physician (5.9%, n = 75), to limit the period of detention (3.4%, n = 43) or to be placed in a large cell (1.0%, n = 13). In 10.2% (n = 130) of cases, other measures (e.g., checking awakenability, sitting guard, changing bandages) were used. With the exception of the latter option, all recommendations were used more frequently in the second period (Fig. 3).
Among the 92 cases with a lack of fitness for custody, hospitalization was recommended most frequently for the group of other specific indications (e.g., diabetes, post-myocardial infarction, epilepsy or injuries requiring surgical treatment), at 41.3% (n = 38). In descending order of frequency, hospital admissions were recommended for mental illness or disorder (21.7%, n = 20), severe traumatic brain injury (12%, n = 11), alcohol intoxication (6.5%, n = 6), alcohol withdrawal syndrome (5.4%, n = 5) and advanced drug withdrawal syndrome (2.2%, n = 2). In addition, there were seven cases (7.6%) in which the persons were transferred to home care and three cases in which a positive assessment could not be issued due to refusal of the medical examination. When comparing the two periods, alcohol-related hospital admissions were more frequent in the first period, while mental diseases/disorders, traumatic brain injuries and other specific indications that led to hospital admissions were more frequent in the second period (Fig. 4).
According to the information on nationality or country of origin in the detainees’ custody documents, at least 25.0% (n = 318) of cases involved a migration background. Furthermore, a language barrier was present in at least 18.2% (n = 232) and an interpreter was called in for 14.2% (n = 181). The frequency of these three factors increased significantly from the first to the second study period (p < 0.001, Fig. 5).