Domino Joseph, McGovern Connie, Chang Kate W C, Carlozzi Noelle E, Yang Lynda J S
School of Medicine, Wayne State University, Detroit; and.
J Neurosurg Pediatr. 2014 Feb;13(2):238-42. doi: 10.3171/2013.11.PEDS13268. Epub 2013 Dec 13.
Perinatal disorders are prone to malpractice litigation. Neonatal brachial plexus palsy (NBPP) results from stretching the nerves in the perinatal period and may lead to paresis or paralysis and sensory loss in the affected arm. Little is known about the key factors associated with malpractice litigation by families of patients with NBPP and whether these factors reflect the practice environment or are inherent to the condition. In this study, the authors documented the percentage of families of NBPP patients at a specialty center that had filed a malpractice suit and described the key factors associated with that pursuit of legal action.
The families/caregivers of 51 patients with NBPP who had presented to the University of Michigan Interdisciplinary Brachial Plexus Program participated in this study. A qualitative research design was applied using both a questionnaire to examine psychosocial factors and a dynamic tool to measure health outcomes from the patient perspective via parent proxy (Patient-Reported Outcomes Measurement Information System [PROMIS] assessment instruments). Statistical analysis included the Fisher exact test, chi-square test, and Student t-test. The study protocol was approved by the University of Michigan institutional review board.
Forty-seven percent of the families pursued malpractice litigation. In comparing patient families that had pursued legal action with those that had not, significant differences were revealed in the perception that the sustained birth injury was unnecessary (p = 0.002), the information received in the perinatal period was inadequate (p = 0.003), family concerns were ignored in the perinatal period (p = 0.005), and family concerns were not adequately addressed (p < 0.001). Sixty-six percent of the families received external advice to pursue legal action. The PROMIS survey revealed significant group differences in depressive symptoms (p = 0.008), fatigue (p = 0.02), pain (p = 0.01), and anger (p = 0.004). In contrast, the extent of NBPP was not associated with malpractice litigation (p = 0.18). Age, sex, and race were not significantly different between litigation and nonlitigation groups.
Physician-controllable factors, such as communication in the perinatal period, are associated with malpractice litigation in NBPP. The perceived level of global disability may affect the pursuit of malpractice litigation, whereas the isolated extent of nerve root involvement and/or upper extremity dysfunction are not significant factors in pursuing litigation. Identifying and ameliorating these factors within the practice environment may decrease the animosity between families and health care providers and improve overall outcome for patients with NBPP.
围产期疾病容易引发医疗事故诉讼。新生儿臂丛神经麻痹（NBPP）是围产期神经受牵拉所致，可导致患侧手臂轻瘫或瘫痪以及感觉丧失。对于NBPP患者家属提起医疗事故诉讼的相关关键因素以及这些因素是反映医疗环境还是该疾病所固有，人们了解甚少。在本研究中，作者记录了一家专科中心NBPP患者家属提起医疗事故诉讼的比例，并描述了与采取法律行动相关的关键因素。
51名就诊于密歇根大学跨学科臂丛神经项目的NBPP患者的家属/护理人员参与了本研究。采用定性研究设计，使用问卷来调查心理社会因素，并使用一种动态工具，通过家长代理从患者角度衡量健康结果（患者报告结果测量信息系统[PROMIS]评估工具）。统计分析包括Fisher精确检验、卡方检验和学生t检验。该研究方案已获密歇根大学机构审查委员会批准。
47%的家属提起了医疗事故诉讼。在比较提起法律诉讼的患者家属与未提起诉讼的家属时，发现以下方面存在显著差异：认为持续性产伤是不必要的（p = 0.002）、围产期获得的信息不足（p = 0.003）、围产期家属的担忧被忽视（p = 0.005）以及家属的担忧未得到充分解决（p < 0.001）。66%的家属接受了采取法律行动的外部建议。PROMIS调查显示，在抑郁症状（p = 0.008）、疲劳（p = 0.02）、疼痛（p = 0.01）和愤怒（p = 0.004）方面存在显著的组间差异。相比之下，NBPP的严重程度与医疗事故诉讼无关（p = 0.18）。诉讼组和非诉讼组在年龄、性别和种族方面无显著差异。
医生可控因素，如围产期的沟通，与NBPP的医疗事故诉讼相关。整体残疾的感知程度可能会影响医疗事故诉讼的提起，而神经根受累的单独程度和/或上肢功能障碍并非提起诉讼的重要因素。在医疗环境中识别并改善这些因素可能会减少家属与医疗服务提供者之间的敌意，并改善NBPP患者的总体预后。
