Marchesi M, Marchesi A, Calori G M, Cireni L V, Sileo G, Merzagora I, Zoia R, Vaienti L, Morini O
Università degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute - Sezione di Medicina Legale e delle Assicurazioni, Italy.
Department of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Italy.
Injury. 2014 Dec;45 Suppl 6:S16-20. doi: 10.1016/j.injury.2014.10.017. Epub 2014 Oct 27.
Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences, therefore, it is important to recognise and treat it early. Good management of ACS minimises or avoids the sequelae associated with a late diagnosis, and may also reduce the risk of malpractice claims. The aim of this article was to evaluate different errors ascribed to the surgeon and to identify how the damage was evaluated.
A total of 66 completed and closed ACS cases were selected. The following were analysed for each case: clinical management before and after diagnosis of ACS, imputed errors, professional fault, damage evaluation and quantification. Particular attention was paid to distinguishing between impairment because of primary injury and iatrogenic impairment. Statistical analyses were performed using Fisher's exact test and Pearson's correlation.
The most common presenting symptom was pain. Delay in the diagnosis, and hence delay in decompression, was common in the study. A total of 48 out of 66 cases resolved with the verdict of iatrogenic damage, which varied from 12% to 75% of global capability of the person. A total of $394,780 out of $574,680 (average payment) derived from a medical error.
ACS is a clinical emergency that requires continuous clinical surveillance from both medical and nursing staff. The related damage should be evaluated in two parts: damage deriving from the trauma, so that it is considered inevitable and independent from the surgeon's conduct, and damage deriving from a surgeon's error, which is eligible for an indemnity payment.
急性骨筋膜室综合征（ACS）是一种可能产生严重后果的临床病症，因此，早期识别和治疗至关重要。对ACS的良好管理可将与延迟诊断相关的后遗症降至最低或避免，还可能降低医疗事故索赔风险。本文旨在评估归因于外科医生的不同失误，并确定如何评估损害情况。
共选取66例已完成并结案的ACS病例。对每个病例分析以下内容：ACS诊断前后的临床管理、推定失误、专业过错、损害评估及量化。特别注意区分原发性损伤导致的损害和医源性损害。采用Fisher精确检验和Pearson相关性进行统计分析。
最常见的症状是疼痛。研究中诊断延迟以及减压延迟很常见。66例病例中有48例判定为医源性损害，损害程度占个人总体能力的12%至75%不等。平均赔偿金额中的574,680美元中有394,780美元源于医疗失误。
ACS是一种临床急症，需要医护人员持续进行临床监测。相关损害应分为两部分评估：因创伤导致的损害，这被视为不可避免且与外科医生的行为无关；因外科医生失误导致的损害，这种损害可获得赔偿。
