Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ.
Int Forum Allergy Rhinol. 2013 Sep;3(9):722-5. doi: 10.1002/alr.21169. Epub 2013 Mar 27.
The potentially severe complications resulting from cerebrospinal fluid (CSF) leak makes iatrogenic injury a medicolegal area of concern for otolaryngologists and neurosurgeons. The objectives of this analysis were to study legal outcomes as well as medical and nonmedical elements affecting malpractice litigation.
Public court records available in the Westlaw legal database (Thomson Reuters, New York, NY) were searched for medical malpractice litigation related to iatrogenic CSF leak. Of the 18 jury verdicts and settlements included, outcomes and awards, patient demographic data, and other factors instrumental in determining legal responsibility were recorded for comparison.
Ten (55.6%) cases were resolved in the defendant's favor, 2 (11.1%) resulted in damages awarded by a jury, and 6 (33.3%) were settled out of court before resolution of trial. Mean damages awarded were $1.1 million, while out of court settlements averaged $966,887. Malpractice stemming from patients who underwent endoscopic sinus surgery comprised 77.8% of cases analyzed. The most frequent alleged factors cited for litigation included having to undergo additional surgery (88.9%), developing meningitis (50.0%), and failing to recognize complications in a timely manner (44.4%). Perceived deficits in informed consent were alleged in one-third of cases.
Although a slight majority of cases were resolved in the defendant's favor, payments made were considerable, averaging approximately $1 million. Strategies to decrease liability and allow patients to make more informed decisions should include clear communication with patients that explicitly states potential risks, such as meningitis, and possible need to undergo additional reparative surgery.
由于脑脊液（CSF）漏导致的潜在严重并发症，使医源性损伤成为耳鼻喉科医生和神经外科医生关注的法律问题。本分析的目的是研究法律结果以及影响医疗事故诉讼的医疗和非医疗因素。
在 Westlaw 法律数据库（Thomson Reuters，纽约，NY）中搜索与医源性 CSF 漏相关的医疗事故诉讼的公开法庭记录。在包括的 18 项陪审团裁决和和解中，记录了结果和裁决、患者人口统计学数据以及其他对确定法律责任有影响的因素，以便进行比较。
10 例（55.6%）以被告胜诉结案，2 例（11.1%）由陪审团判给损害赔偿金，6 例（33.3%）在审判前庭外和解。判给的平均赔偿金为 110 万美元，而庭外和解的平均金额为 966,887 美元。分析的病例中，内镜鼻窦手术引起的医疗事故占 77.8%。诉讼中最常被指控的因素包括不得不进行额外的手术（88.9%）、患脑膜炎（50.0%）以及未能及时发现并发症（44.4%）。三分之一的案件被指控在知情同意方面存在缺陷。
尽管略占多数的案件以被告胜诉结案，但支付的款项相当可观，平均约为 100 万美元。减少责任和允许患者做出更明智决策的策略应包括与患者明确沟通，明确说明潜在风险，如脑膜炎和可能需要进行额外的修复手术。
