Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195-6540, USA.
Anesth Analg. 2012 Nov;115(5):1196-203. doi: 10.1213/ANE.0b013e31826ac344. Epub 2012 Sep 13.
Trauma care has many challenges, including the perception by nonanesthesia physicians of increased medical malpractice liability. We used the American Society of Anesthesiologists' Closed Claims Project database and the National Inpatient Sample (NIS) to compare the rate of claims for trauma anesthesia care to national trauma surgery data. We also used the American Society of Anesthesiologists' Closed Claims Project database to evaluate injury and liability profiles of trauma anesthesia malpractice claims compared to nontrauma surgical anesthesia claims.
Surgical anesthesia claims for injuries that occurred between 1980 and 2005 in the American Society of Anesthesiologists' Closed Claims Project database of 8954 claims were included in this analysis. Trauma was defined using cause of injury criteria in state trauma registries, including out-of-hospital falls. To estimate national trauma anesthesia rates, we used injury codes in NIS reports to define trauma discharges and NIS discharges with surgical procedure codes for the denominator. The year-adjusted odds ratio and P value comparing the national trauma anesthesia injury rates and American Society of Anesthesiologists' Closed Claims Project inpatient claim rates in the 1990 to 2001 time period were calculated by a multivariate logistic regression of the injury/trauma outcome on year and the NIS/Closed Claims Project indicator. Payments in claim resolution between trauma claims and nontraumatic surgical anesthesia claims were compared by χ(2) analysis, Fisher exact test for proportions, and Kolmogorov-Smirnov test for payment amounts.
Trauma claims represented 6% of the total 6215 surgical anesthesia claims in the study period. The inpatient trauma claims rates were consistently lower than the NIS injury rates for 1990 to 2001. The year-adjusted odds ratio comparing the trauma claims rates to the NIS injury rates was 0.62 (95% confidence interval [CI], 0.53 to 0.72; P < 0.001, likelihood ratio test). Trauma claims and nontrauma surgical anesthesia claims did not differ in appropriateness of care, whether or not a payment was made to the plaintiff, or size of payments.
Despite reported perceptions that trauma care involves a high risk of medical liability, there was no apparent increased risk of liability among inpatients presenting for trauma anesthesia care. The proportion in malpractice claims in trauma anesthesia care was not increased compared to nontraumatic surgical anesthesia care. With respect to medicolegal liability, these results support participation of anesthesia providers in multidisciplinary trauma care and organized systems.
创伤护理面临诸多挑战，包括非麻醉医师对医疗事故责任增加的看法。我们使用美国麻醉师协会（ASA）的已结案索赔项目数据库和国家住院患者样本（NIS），将创伤麻醉护理的索赔率与全国创伤外科数据进行比较。我们还使用 ASA 的已结案索赔项目数据库，评估与非创伤外科麻醉索赔相比，创伤麻醉医疗事故索赔的伤害和责任概况。
在包含 8954 项索赔的 ASA 已结案索赔项目数据库中，纳入了 1980 年至 2005 年间发生的外科麻醉伤害索赔。使用州创伤登记处的伤害原因标准定义创伤，包括院外跌倒。为了估计全国创伤麻醉发生率，我们使用 NIS 报告中的伤害代码定义创伤出院和具有外科手术代码的 NIS 出院作为分母。通过对 1990 年至 2001 年期间伤害/创伤结果与年份以及 NIS/已结案索赔项目指标的多元逻辑回归，计算全国创伤麻醉伤害发生率和 ASA 住院患者索赔率的年调整比值比（OR）和 P 值。通过卡方分析、比例 Fisher 确切检验和支付金额的 Kolmogorov-Smirnov 检验比较创伤索赔和非创伤性外科麻醉索赔之间的索赔解决支付。
研究期间，创伤索赔占总数 6215 项外科麻醉索赔的 6%。1990 年至 2001 年期间，住院创伤索赔率始终低于 NIS 伤害率。创伤索赔率与 NIS 伤害率的年调整 OR 为 0.62（95%置信区间[CI]，0.53 至 0.72；P <0.001，似然比检验）。在护理是否适当、是否向原告支付赔偿或赔偿金额大小方面，创伤索赔和非创伤性外科麻醉索赔没有差异。
尽管有报道称创伤护理存在高医疗责任风险，但接受创伤麻醉护理的住院患者并未明显增加责任风险。与非创伤性外科麻醉护理相比，创伤麻醉护理中的医疗事故索赔比例并未增加。就医疗法律责任而言，这些结果支持麻醉提供者参与多学科创伤护理和有组织的系统。
