Lindor Rachel A, Boie Eric T, Campbell Ronna L, Hess Erik P, Sadosty Annie T
Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN.
Acad Emerg Med. 2015 Dec;22(12):1493-8. doi: 10.1111/acem.12823. Epub 2015 Nov 17.
The objectives were to describe lawsuits against providers for failing to order head computed tomography (CT) in cases of head trauma and to determine the potential effects of available clinical decision rules (CDRs) on each lawsuit.
The authors collected jury verdicts, settlements, and court opinions regarding alleged malpractice for failure to order head CT in the setting of head trauma from 1972 through February 2014 from an online legal research tool (WestlawNext). Data were abstracted onto a standardized data form. The performance of five CDRs was evaluated.
Sixty relevant cases were identified (52 adult, eight children). Of 48 cases with known outcomes, providers were found negligent in 10 cases (six adult, four pediatric), settled in 11 cases (nine adult, two pediatric), and were found not liable in 27 cases. In all 10 cases in which providers were found negligent, every applicable CDR studied would have indicated the need for head CT. In all eight cases involving children, the applicable CDR would have suggested the need for head CT or observation.
A review of legal cases reported in a major online legal research system revealed 60 lawsuits in which providers were sued for failing to order head CTs in cases of head trauma. In all cases in which providers were found negligent, CT imaging or observation would have been indicated by every applicable CDR.
本研究旨在描述针对头部创伤病例中未开具头部计算机断层扫描（CT）的医疗服务提供者的诉讼情况，并确定现有临床决策规则（CDR）对每起诉讼的潜在影响。
作者从在线法律研究工具（WestlawNext）中收集了1972年至2014年2月期间关于头部创伤情况下未开具头部CT的医疗事故指控的陪审团裁决、和解协议和法院意见。数据被提取到标准化的数据表格中。对五个CDR的性能进行了评估。
共识别出60例相关案例（52例成人，8例儿童）。在48例已知结果的案例中，医疗服务提供者在10例中被认定有过失（6例成人，4例儿童），11例达成和解（9例成人，2例儿童），27例被认定无责任。在所有10例医疗服务提供者被认定有过失的案例中，每一项适用的CDR都会表明需要进行头部CT检查。在所有8例涉及儿童的案例中，适用的CDR都会建议进行头部CT检查或观察。
对一个主要在线法律研究系统中报告的法律案例进行回顾发现，有60起诉讼指控医疗服务提供者在头部创伤病例中未开具头部CT。在所有医疗服务提供者被认定有过失的案例中，每一项适用的CDR都会表明需要进行CT成像或观察。
