Gild W M, Posner K L, Caplan R A, Cheney F W
Department of Anesthesiology, University of Washington School of Medicine, Seattle.
Anesthesiology. 1992 Feb;76(2):204-8. doi: 10.1097/00000542-199202000-00008.
Claims against anesthesiologists for eye injuries were analyzed as part of the ASA Closed Claims Project. Eye injury occurred in 3% of all claims in the database (71 of 2,046). The payment frequency for eye injury claims was higher than that for non-eye injury claims (70% vs. 56%; P less than or equal to 0.05). The median cost of eye injury claims was less than that for other claims ($24,000 vs. $95,000; P less than or equal to 0.01). Two distinct subsets were identified. The first was characterized by corneal abrasion during general anesthesia (25 of 71 claims; 35%). Claims for corneal abrasion were characterized by low incidence of permanent injury (16%) and low median payment ($3,000). Reviewers were able to identify a mechanism of injury in only 20% of claims for corneal abrasion. The second subset of eye injury was characterized by patient movement during ophthalmologic surgery (21 of 71; 30%). Blindness was the outcome in all cases. Sixteen of the claims involving movement occurred during general anesthesia, and 5 occurred during monitored anesthesia care. The median payment for claim involving movement was 10 times greater than for non-movement claims ($90,000 vs. $9,000; P less than or equal to 0.01). Anesthesiologist reviewers deemed the care rendered in the general anesthesia "movement" claims as meeting standards in only 19% of claims. From the perspective of patient safety, as well as risk management, these data suggest two specific needs: research directed at better understanding of the etiology of corneal abrasion and clinical strategies designed to assure patient immobility during ophthalmic surgery.
作为美国麻醉医师协会（ASA）结案索赔项目的一部分，对针对麻醉医师的眼部损伤索赔进行了分析。数据库中所有索赔中有3%发生了眼部损伤（2046例中的71例）。眼部损伤索赔的赔付频率高于非眼部损伤索赔（70%对56%；P≤0.05）。眼部损伤索赔的中位数成本低于其他索赔（24,000美元对95,000美元；P≤0.01）。确定了两个不同的子集。第一个子集的特征是全身麻醉期间角膜擦伤（71例索赔中的25例；35%）。角膜擦伤索赔的特征是永久性损伤发生率低（16%）和中位数赔付低（3,000美元）。在仅20%的角膜擦伤索赔中，评审人员能够确定损伤机制。眼部损伤的第二个子集的特征是眼科手术期间患者移动（71例中的21例；30%）。所有病例的结果都是失明。涉及移动的索赔中有16例发生在全身麻醉期间，5例发生在麻醉监测护理期间。涉及移动的索赔的中位数赔付比不涉及移动的索赔高10倍（90,000美元对9,000美元；P≤0.01）。麻醉医师评审人员认为，在全身麻醉“移动”索赔中提供的护理仅在19%的索赔中符合标准。从患者安全以及风险管理的角度来看，这些数据表明了两个具体需求：旨在更好地了解角膜擦伤病因的研究以及旨在确保眼科手术期间患者不动的临床策略。
