Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990-2015
Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990-2015
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中国上海致命医疗事故案件诊断错误：1990-2015
DOI：
10.1186/s13000-019-0785-5
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发表时间：
2019-01-31
影响因子：
2.6
通讯作者：
Li, Liliang
中科院分区：
文献类型：
--
作者：
Gao, Pan;Li, Xiaoqiang;Li, Liliang
背景我国医疗纠纷问题依然存在。以往的研究表明，在发达国家，诊断差异随着时间的推移而变化，但在中国，诊断差异仍然是研究不足，特别是在医疗纠纷的设置。我们试图描述的医疗纠纷的诊断差异的年为基础的变化，并确定与类的诊断discrimination.MethodsWe相关的因素进行了回顾性队列研究的所有医疗纠纷的情况下，从1990年到2015年在中国上海，使用尸检作为诊断的金标准。根据国家立法时代对案件进行了分组。诊断差异分为重大错误（I和II类），轻微错误（III和IV类），没有差异（V类）和未确定（VI类）的差异严重程度的基础上。病例主要为男性（男：女=1.6：1），且集中于10岁以下或50 - 70岁的患者。主要和次要差异分别占51.7%和34.8%。55例病例（11.2%）为无差异（V类）。在第一轮立法之前，纠纷率仍然很高（平均每100万患者0.31），但之后急剧下降（R-2=-0.82，p
BackgroundMedical disputes remain unabated in China. Previous studies have shown the changes of diagnostic discrepancy over time in developed countries, but diagnostic discrepancy remains understudied in China, especially in the setting of medical disputes. We sought to describe the year-based changes of diagnostic discrepancies in medical disputes, and to identify factors associated with classes of diagnostic discrepancy.MethodsWe conducted a retrospective cohort study of all medically disputed cases from 1990 through 2015 in Shanghai, China, with use of necropsy as the gold standard for diagnosis. Cases were grouped based on national legislative eras. Diagnostic discrepancy was classified as major errors (class I and II), minor errors (class III and IV), no discrepancy (class V) and undetermined (class VI) based on discrepancy severity.ResultsThere were 482 medical disputes. Cases were predominantly males (male: female=1.6:1) and concentrated in patients less than 10years old or between 50 and 70years. Major and minor discrepancy accounted for 51.7 and 34.8%, respectively. Fifty-five cases (11.2%) were non-discrepant (Class V). The dispute rate remained high before the first round of legislation (mean 0.31 per 1 million patients) but declined dramatically afterwards (R-2=-0.82, p