Department of Orthopedics, Alfred I Dupont Hospital for Children, Wilmington, Delaware.
From the Department of Orthopedics, Phoenix Children's Hospital.
J Patient Saf. 2021 Dec 1;17(8):e1088-e1096. doi: 10.1097/PTS.0000000000000484.
Medical malpractice is burdensome to the U.S. healthcare system. The following is an epidemiological analysis of the closed medical professional liability (MPL) claims in pediatric orthopedics using data maintained by the Physician Insurers Association of America.
The Physician Insurers Association of America registry of MPL claims from 1985 to 2013 for all specialties included 286,021 closed claims in the United States. All closed MPL claims for orthopedic surgery in patients younger than 18 years were retrospectively reviewed (N = 2,671). The error categories, result of the claim, the most common procedures, severity of injury, and the most common presenting and resultant medical conditions were reported with the paid-to-close ratios, average indemnity payment, and average cost of litigation. The pediatric orthopedic population was compared with all orthopedics. The data were adjusted for inflation and trended for the 29-year period.
Of the 2671 pediatric orthopedic claims, 881 resulted in a payment and the average indemnity was U.S. $317,574 with adjustment for inflation - significantly higher than for all of orthopedics at U.S. $268,817 (P = 0.0013). The paid-to-close ratio was 33.0%, compared with 28.7% for all of orthopedics (P = 0.023).
Costs to defend individual medical malpractice claims and the average indemnity payment per claim have both increased over time, and pediatric (versus adult) orthopedic claims are more likely to result in payment and result in a higher payment. Knowledge of the details of liability claims should assist practicing general and pediatric orthopedic surgeons in improving patient safety and quality of care, reducing patient injury, and reducing the incidence of MPL claims.
医疗事故对美国医疗保健系统造成了沉重负担。以下是使用美国医师保险公司（Physician Insurers Association of America）的数据对小儿矫形外科封闭医疗专业责任（MPL）索赔进行的流行病学分析。
美国医师保险公司的 MPL 索赔登记处从 1985 年至 2013 年涵盖了所有专业的 286021 件已结案索赔。回顾性审查了所有年龄小于 18 岁的骨科手术患者的所有已结案 MPL 索赔（N=2671）。报告了错误类别、索赔结果、最常见的手术、损伤严重程度以及最常见的就诊和最终医疗状况，并附有支付-结案比、平均赔偿金和诉讼平均成本。将小儿矫形外科人群与所有矫形外科进行了比较。对数据进行了通胀调整，并在 29 年期间进行了趋势分析。
在 2671 例小儿矫形外科索赔中，有 881 例导致了付款，经通胀调整后的平均赔偿金为 317574 美元，明显高于所有矫形外科的 268817 美元（P=0.0013）。支付-结案比为 33.0%，而所有矫形外科的支付-结案比为 28.7%（P=0.023）。
为每个医疗事故索赔辩护的成本以及每个索赔的平均赔偿金都随着时间的推移而增加，儿科（相对于成人）矫形外科索赔更有可能导致付款，并导致更高的赔偿金。了解责任索赔的细节应该有助于执业的普通和小儿矫形外科医生提高患者安全性和护理质量，减少患者损伤，并降低 MPL 索赔的发生率。
