Üzün İbrahim, Özdemir Erdinç, Esen Melez İpek, Melez Deniz Oğuzhan, Akçakaya Adem
The Ministry of Justice Council of Forensic Medicine, İstanbul; Department of Forensic Medicine, Akdeniz University Faculty of Medicine, Antalya-Turkey.
Muş Branch Office, The Ministry of Justice Council of Forensic Medicine, Muş-Turkey.
Ulus Travma Acil Cerrahi Derg. 2016 Jul;22(4):365-73. doi: 10.5505/tjtes.2015.26543.
General surgery is one of the branches in which the distinction between complication and malpractice is difficult to distinguish. In this study, presentation of the main forensic medical parameters considered for the evaluation of medical malpractice in cases of general surgery deaths in which medical malpractice has been alleged and discussing related concepts through the literature are aimed.
Allegations of medical malpractice against general surgery physicians sent to the First Forensic Expertise Board of the Council of Forensic Medicine between January 1, 2012 and December 31, 2013 for which the relation of casuality between medical malpractice and death had been determined were retrospectively evaluated.
Medical malpractice was ruled in 21.9% (n=23) of 105 cases. The most common primary disease diagnoses were trauma-injury (n=32, 30.5%), cholecystitis (n=25, 23.8%) and appendicitis (n=8, 7.6%). When treatment types were compared according to malpractice decision, rate of malpractice in medicine-only treatment was found to be significantly higher compared to surgery + medical treatment (p=0.003, p<0.01). No statistically significant difference was found regarding the rate of malpractice between cases of emergency and elective surgery (p>0.05). When incidence of medical malpractice was compared between cases with clinical diagnosis and diagnosis determined by autopsy, a statistically significant difference was found (p=0.031, p<0.05). Malpractice was ruled at a significantly lower rate in cases in which diagnosis was confirmed with autopsy (p=0.028, p<0.05).
It can be concluded that physicians are as successful in emergency conditions as in elective conditions and correct administration of medical treatment is of vital importance. Moreover, the Council of Forensic Medicine considers the clinical follow-up data as well as the autopsy data in medical malpractice evaluation.
普通外科是并发症与医疗事故难以区分的分支领域之一。本研究旨在呈现普通外科死亡病例中被认为用于评估医疗事故的主要法医医学参数，并通过文献探讨相关概念。
回顾性评估2012年1月1日至2013年12月31日期间送交法医委员会第一法医鉴定委员会的针对普通外科医生的医疗事故指控，这些指控已确定医疗事故与死亡之间的因果关系。
105例病例中有21.9%（n = 23）被判定存在医疗事故。最常见的原发性疾病诊断为创伤损伤（n = 32，30.5%）、胆囊炎（n = 25，23.8%）和阑尾炎（n = 8，7.6%）。根据医疗事故判定结果比较治疗类型时，发现单纯药物治疗的医疗事故发生率显著高于手术 + 药物治疗（p = 0.003，p < 0.01）。急诊手术和择期手术病例的医疗事故发生率无统计学显著差异（p > 0.05）。比较临床诊断病例和尸检确定诊断病例的医疗事故发生率时，发现有统计学显著差异（p = 0.031，p < 0.05）。尸检确诊病例的医疗事故判定率显著较低（p = 0.028，p < 0.05）。
可以得出结论，医生在急诊情况下与择期情况下一样成功，正确的医疗治疗管理至关重要。此外，法医委员会在医疗事故评估中会考虑临床随访数据以及尸检数据。
