The Causes of Medical Malpractice Suits against Radiologists in the United States
The Causes of Medical Malpractice Suits against Radiologists in the United States
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DOI：
10.1148/radiol.12111119
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发表时间：
2013-02-01
期刊：
影响因子：
19.7
通讯作者：
Castro, Alejandro, III
中科院分区：
文献类型：
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作者：
Whang, Jeremy S.;Baker, Stephen R.;Castro, Alejandro, III
目的：从8401名放射科医生的资质数据中确定医疗事故诉讼最常见的原因。材料和方法：本研究经新泽西医学院机构审查委员会批准。参与One-Call Medical网络的47个州共有8401名放射科医生被要求提供他们的医疗事故历史，作为其资格申请的一部分。One-Call Medical是一个在工人赔偿案件中进行计算机断层扫描/磁共振研究的经纪人。其中，2624名（31%）放射科医生在其职业生涯中至少有一次索赔。在每个登记者的证书文件中，如果对登记者提出索赔，则有关于每个医疗事故案件的叙述，在大多数情况下，可以从中看出主要指控。在4793起案件中，有4043起（84%）的案件可以从叙述中得出所谓的原因。采用Stata 12 （2011; Stata, College Station, Tex）软件进行统计分析。结果：最常见的一般原因是诊断错误（14.83例/ 1000人年[95%可信区间{CI}: 14.19, 15.51]）。在这一类别中，乳腺癌是最常见的漏诊（每1000人年3.57次索赔[95% CI: 3.26, 3.91]），其次是非脊柱骨折（每1000人年2.49次索赔[95% CI: 2.28, 2.72]）、脊柱骨折（每1000人年1.32次索赔[95% CI: 1.16, 1.49]）、肺癌（每1000人年1.26次索赔[95% CI: 1.11, 1.42]）和血管疾病（每1000人年1.08次索赔[95% CI: 0.93, 1.24]）。其次是手术并发症（每1000人年1.76次索赔[95% CI: 1.58, 1.96]），其次是与患者（每1000人年0.40次索赔[95% CI: 0.32, 0.50]）或转诊者（每1000人年0.71次索赔[95% CI: 0.60, 0.84]）沟通不足。放射科医生在每1000人年0.92例索赔中仅起次要作用（95% CI: 0.77, 1.10）。未推荐额外检查是罕见的原因（0.41索赔每1000人年[95% CI: 0.34, 0.50]）。结论：到目前为止，诊断错误是针对放射科医生的医疗事故诉讼中最常见的一般原因。在这一类别中，乳腺癌是最常被漏诊的，其次是非椎体骨折和脊柱骨折。沟通失败和建议额外测试失败都是发起诉讼的不常见原因。(C) RSNA, 2012年
Purpose: To determine the most frequent causes of malpractice suits as derived from credentialing data of 8401 radiologists.Materials and Methods: This study was approved by the Institutional Review Board of New Jersey Medical School. A total of 8401 radiologists in 47 states participating in the network of One-Call Medical, a broker for computed tomographic/magnetic resonance studies in workers' compensation cases, were required to provide their malpractice history as part of their credentialing application. Of these, 2624 (31%) radiologists had at least one claim in their career. In each enrollee's credentialing file, if there was a claim against the enrollee there was a narrative regarding each malpractice case from which, in most instances, a primary allegation could be discerned. Among the 4793 cases, an alleged cause could be derived from the narrative in 4043 (84%). Statistical analysis was performed with Stata 12 (2011; Stata, College Station, Tex) software.Results: The most common general cause was error in diagnosis (14.83 claims per 1000 person-years [95% confidence interval {CI}: 14.19, 15.51]). In this category, breast cancer was the most frequently missed diagnosis (3.57 claims per 1000 person-years [95% CI: 3.26, 3.91]), followed by non-spinal fractures (2.49 claims per 1000 person-years [95% CI: 2.28, 2.72]), spinal fractures (1.32 claims per 1000 person-years [95% CI: 1.16, 1.49]), lung cancer (1.26 claims per 1000 person-years [95% CI: 1.11, 1.42]), and vascular disease (1.08 claims per 1000 person-years [95% CI: 0.93, 1.24]). The category next in frequency was procedural complications (1.76 claims per 1000 person-years [95% CI: 1.58, 1.96]), followed by inadequate communication with either patient (0.40 claim per 1000 person-years [95% CI: 0.32, 0.50]) or referrer (0.71 claim per 1000 person-years [95% CI: 0.60, 0.84]). Radiologists had only a peripheral role in 0.92 claim per 1000 person-years (95% CI: 0.77, 1.10). Failure to recommend additional testing was a rare cause (0.41 claim per 1000 person-years [95% CI: 0.34, 0.50]).Conclusion: Errors in diagnosis are, by far, the most common generic cause of malpractice suits against radiologists. In this category, breast cancer was the most frequently missed diagnosis, followed by nonvertebral fractures and spinal fractures. Failure to communicate and failure to recommend additional testing are both uncommon reasons for initiating a suit. (C)RSNA, 2012