Brennan T A, Leape L L, Laird N M, Hebert L, Localio A R, Lawthers A G, Newhouse J P, Weiler P C, Hiatt H H
Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Qual Saf Health Care. 2004 Apr;13(2):145-51; discussion 151-2. doi: 10.1136/qshc.2002.003822.
As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.
We reviewed 30121 randomly selected records from 51 randomly selected acute care, non-psychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.
Adverse events occurred in 3.7% of the hospitalizations (95% confidence interval 3.2 to 4.2), and 27.6% of the adverse events were due to negligence (95% confidence interval 22.5 to 32.6). Although 70.5% of the adverse events gave rise to disability lasting less than 6 months, 2.6% caused permanently disabling injuries and 13.6% led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test chi(2) = 21.04, p<0.0001). Using weighted totals we estimated that among the 2671863 patients discharged from New York hospitals in 1984 there were 98609 adverse events and 27179 adverse events involving negligence. Rates of adverse events rose with age (p<0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (p<0.01). There were significant differences in rates of adverse events among categories of clinical specialties (p<0.0001), but no differences in the percentage due to negligence.
There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.
作为医学伤害与医疗事故诉讼跨学科研究的一部分，我们估算了不良事件（定义为由医疗处理导致的伤害）以及因疏忽或不达标护理导致的此类伤害亚组的发生率。
我们回顾了1984年从纽约州51家随机选取的非精神科急症医院中随机抽取的30121份记录。然后我们根据患者的年龄和性别以及医生的专业对伤害情况进行了总体估算并计算了发生率。
不良事件发生在3.7%的住院病例中（95%置信区间为3.2%至4.2%），27.6%的不良事件是由疏忽导致的（95%置信区间为22.5%至32.6%）。尽管70.5%的不良事件导致的残疾持续时间不到6个月，但2.6%造成了永久性致残伤害，13.6%导致了死亡。在更严重伤害类别中，因疏忽导致的不良事件百分比有所增加（Wald检验卡方值=21.04，p<0.0001）。使用加权总数，我们估计1984年从纽约医院出院的2671863名患者中，有98609起不良事件，27179起涉及疏忽的不良事件。不良事件发生率随年龄增长而上升（p<0.0001）。老年人中因疏忽导致的不良事件百分比明显更高（p<0.01）。不同临床专业类别的不良事件发生率存在显著差异（p<0.0001），但因疏忽导致的百分比没有差异。
医疗处理给患者造成了大量伤害，许多伤害是不达标护理的结果。
