Kolaitis Irini N, Schinasi Dana Aronson, Ross Lainie Friedman
Division of Hospital Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Acad Pediatr. 2016 Jul;16(5):482-488. doi: 10.1016/j.acap.2015.06.011. Epub 2015 Aug 29.
Limited data exist on medical error disclosure in pediatrics. We sought to assess physicians' attitudes toward error disclosure to parents and pediatric patients.
An anonymous survey was distributed to 1200 members of the American Academy of Pediatrics. Surveys included 1 of 4 possible cases that only varied by patient age (16 or 9 years old) and by whether the medical error resulted in reversible or irreversible harm. Statistical analyses included chi-square, Bonferroni-adjusted P values, Fisher's exact test, Wilcoxon signed rank test, and logistic regressions including key demographic factors, patient age, and error reversibility.
The response rate was 40% (474 of 1186). Overall, 98% of respondents believed it was very important to disclose medical errors to parents versus 57% to pediatric patients (P < .0001). Respondents believed that medical errors could be disclosed to developmentally appropriate pediatric patients at a mean age of 12.15 years old (SD 3.33), but not below a mean age of 10.25 years old (SD 3.55). Most respondents (72%) believed that physicians and parents should jointly decide whether to disclose to pediatric patients. When disclosing to pediatric patients, 88% of respondents believed that physicians should disclose with the parents present. Logistic regressions found only patient age (odds ratio 18.65, 95% confidence interval 9.20-37.8) and error reversibility (odds ratio 2.90, 95% confidence interval 1.73-4.86) to affect attitudes toward disclosure to pediatric patients. Respondent sex, year of medical school graduation, and area of practice had no effect on disclosure attitudes.
Most respondents endorse disclosing medical errors to parents and older pediatric patients, particularly when irreversible harm occurs.
关于儿科医疗差错披露的数据有限。我们试图评估医生对向家长和儿科患者披露差错的态度。
向1200名美国儿科学会成员发放了一份匿名调查问卷。调查包含4种可能案例中的1种，这些案例仅在患者年龄（16岁或9岁）以及医疗差错导致的是可逆还是不可逆伤害方面有所不同。统计分析包括卡方检验、经邦费罗尼校正的P值、费舍尔精确检验、威尔科克森符号秩检验以及包含关键人口统计学因素、患者年龄和差错可逆性的逻辑回归分析。
回复率为40%（1186份问卷中有474份回复）。总体而言，98%的受访者认为向家长披露医疗差错非常重要，而向儿科患者披露差错的比例为57%（P <.0001）。受访者认为，对于发育正常的儿科患者，平均在12.15岁（标准差3.33）时可以披露医疗差错，但平均年龄低于10.25岁（标准差3.55）时则不可以。大多数受访者（72%）认为医生和家长应共同决定是否向儿科患者披露差错。在向儿科患者披露差错时，88%的受访者认为医生应在家长在场的情况下进行披露。逻辑回归分析发现，仅患者年龄（优势比18.65，95%置信区间9.20 - 37.8）和差错可逆性（优势比2.90，95%置信区间1.73 - 4.86）会影响对向儿科患者披露差错的态度。受访者的性别、医学院毕业年份和执业领域对披露态度没有影响。
大多数受访者支持向家长和年龄较大的儿科患者披露医疗差错，尤其是在发生不可逆伤害的情况下。
