Oetgen Matthew E, Parikh P Divya
*Department of Orthopaedics and Sports Medicine, Children's National Medical Center, Washington, DC †Research and Risk Management, Physician Insurers Association of America, Rockville, MD.
J Pediatr Orthop. 2016 Mar;36(2):213-7. doi: 10.1097/BPO.0000000000000412.
Medical liability exposure varies based on scope of practice, patient demographics, and location of practice. There is a generally held belief that treatment of pediatric patients increases one's medicolegal risk. We examined a large national database of orthopaedic malpractice claims to determine if pediatric malpractice claims were associated with a less favorable medicolegal outcome compared with adults.
Physician Insurers Association of America is an association of medical liability insurance carriers providing liability coverage for 60% of private practice physicians in the United States. The Physician Insurers Association of America data registry of closed medical liability claims was examined, including all orthopaedic claims between 1985 and 2012 in this review. Claims were categorized based on the age of the claimant (pediatric: less than 21 y, adult: 21 y or older). These groups were compared based on percentage of claims resulting in payment, indemnity paid, and years between occurrence of incident and filing of claim. In addition, the top 10 most prevalent claims were identified and compared between groups.
A total of 25,702 closed orthopaedic claims were included. Pediatric claims accounted for 13% of the data. The average time from incident to claim filing was 1.92 years for pediatrics and 1.59 years for adults. Pediatric claims resulted in a higher percent of payment (33% vs. 30%) and average indemnity paid ($189,732 vs. $180,171) compared with adults. Five of the top 10 conditions resulting in a claim in each group were the same. Comparing these 5 conditions, in general there were minimal differences in the average time to claim filing between the groups, but larger average indemnity paid in the pediatric group.
There appear to be moderate differences in outcomes of orthopaedic malpractice claims between adult and pediatric patients. The longer statute of limitations associated with pediatric claims does not appear to portend a less favorable medicolegal outcome or excessively longer time to claims filing for pediatric patients.
医疗责任风险因执业范围、患者人口统计学特征及执业地点而异。人们普遍认为，治疗儿科患者会增加医疗法律风险。我们研究了一个大型全国性骨科医疗事故索赔数据库，以确定儿科医疗事故索赔与成人相比，是否会带来更不利的医疗法律结果。
美国医师保险协会是一个医疗责任保险公司协会，为美国60%的私人执业医师提供责任保险。研究了美国医师保险协会已结案医疗责任索赔数据登记处的数据，本综述涵盖1985年至2012年期间的所有骨科索赔。索赔根据索赔人的年龄进行分类（儿科：小于21岁，成人：21岁及以上）。比较了这些组在索赔获赔百分比、支付的赔偿金以及事件发生到索赔提交之间的年份。此外，确定了最常见的10项索赔，并在组间进行比较。
共纳入25702例已结案的骨科索赔。儿科索赔占数据的13%。儿科索赔从事件到索赔提交的平均时间为1.92年，成人为1.59年。与成人相比，儿科索赔的获赔百分比更高（33%对30%），平均支付的赔偿金更高（189732美元对180171美元）。每组导致索赔的前10种情况中有5种相同。比较这5种情况，总体而言，各组之间索赔提交的平均时间差异最小，但儿科组支付的平均赔偿金更高。
成人和儿科患者的骨科医疗事故索赔结果似乎存在适度差异。与儿科索赔相关的较长诉讼时效似乎并不预示着儿科患者会有更不利的医疗法律结果，也不会导致索赔提交时间过长。
