Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
Am J Emerg Med. 2011 Jul;29(6):656-64. doi: 10.1016/j.ajem.2010.01.038. Epub 2010 Jul 13.
Physicians' fears of being sued may lead to defensive medical practices, such as ordering nonindicated medical imaging. We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency department with mild head trauma.
We assessed neurologic imaging among a national sample of 8588 women residing in 10 US states evaluated in an emergency setting for head injury between January 1, 1992, and December 31, 2001. We assessed the odds of imaging as it varied by the enactment of medical liability reform laws.
The medical liability reform laws were significantly associated with the likelihood of imaging. States with laws that limited monetary damages (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.40-0.99), mandated periodic award payments (OR, 0.64; 95% CI, 0.43-0.97), or specified collateral source offset rules (OR, 0.62; 95% CI, 0.40-0.96) had an approximately 40% lower odds of imaging, whereas states that had laws that limited attorney's contingency fees had significantly higher odds of imaging (OR, 1.5; 95% CI, 0.99-2.4), compared to states without these laws. When we used a summation of the number of laws in place, the greater the number of laws, the lower the odds of imaging. In the multivariate analysis, after adjusting for individual and community factors, the total number of laws remained significantly associated with the odds of imaging, and the effect of the individual laws was attenuated, but not eliminated.
The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices.
医生对被起诉的恐惧可能导致防御性医疗行为，例如开具不必要的医学影像检查。我们研究了美国各州的医疗事故侵权改革与因轻度头部外伤在急诊就诊的患者神经影像学检查率之间的关系。
我们评估了 1992 年 1 月 1 日至 2001 年 12 月 31 日期间，在急诊因头部外伤评估的 10 个美国州居住的 8588 名女性的神经影像学检查情况。我们根据医疗责任改革法的颁布情况评估了影像检查的几率。
医疗责任改革法与影像检查的可能性显著相关。限制损害赔偿金的州（比值比[OR]，0.63；95%置信区间[CI]，0.40-0.99）、规定定期裁决支付的州（OR，0.64；95%CI，0.43-0.97）或规定间接赔偿规则的州（OR，0.62；95%CI，0.40-0.96），其进行影像检查的可能性约降低 40%，而限制律师代理费用的州进行影像检查的可能性显著升高（OR，1.5；95%CI，0.99-2.4），与没有这些法律的州相比。当我们使用实施的法律数量总和时，法律数量越多，进行影像检查的可能性越低。在多变量分析中，调整个体和社区因素后，法律总数与影像检查的几率仍然显著相关，个别法律的作用减弱，但并未消除。
我们研究的侵权改革与获取神经影像学检查的倾向相关。如果在更大的研究中证实了这些结果，侵权改革可能会减轻防御性医疗行为。
