Postgraduate Clinical Training Center, Shimane University Hospital, Izumo, Shimane, Japan.
Okinawa Muribushi Project for Teaching Hospitals, Okinawa, Japan.
PLoS One. 2020 Aug 3;15(8):e0237145. doi: 10.1371/journal.pone.0237145. eCollection 2020.
Diagnostic errors are prevalent and associated with increased economic burden; however, little is known about their characteristics at the national level in Japan. This study aimed to investigate clinical outcomes and indemnity payment in cases of diagnostic errors using Japan's largest database of national claims.
We analyzed characteristics of diagnostic error cases closed between 1961 and 2017, accessed through the national Japanese malpractice claims database. We compared diagnostic error-related claims (DERC) with non-diagnostic error-related claims (non-DERC) in terms of indemnity, clinical outcomes, and factors underlying physicians' diagnostic errors.
All 1,802 malpractice claims were included in the analysis. The median patient age was 33 years (interquartile range = 10-54), and 54.2% were men. Deaths were the most common outcome of claims (939/1747; 53.8%). In total, 709 (39.3%, 95% CI: 37.0%-41.6%) DERC cases were observed. The adjusted total billing amount, acceptance rate, adjusted median claims payments, and proportion of deaths were significantly higher in DERC than non-DERC cases. Departments of internal medicine and surgery were 1.42 and 1.55 times more likely, respectively, to have DERC cases than others. Claims involving the emergency room (adjusted odds ratio [OR] = 5.88) and outpatient office (adjusted OR = 2.87) were more likely to be DERC than other cases. The initial diagnoses most likely to lead to diagnostic error were upper respiratory tract infection, non-bleeding digestive tract disease, and "no abnormality."
Cases of diagnostic errors produced severe patient outcomes and were associated with high indemnity. These cases were frequently noted in general exam and emergency rooms as well as internal medicine and surgery departments and were initially considered to be common, mild diseases.
诊断错误普遍存在，并与经济负担增加有关；然而，在日本，人们对其全国范围内的特征知之甚少。本研究旨在利用日本最大的国家索赔数据库，调查诊断错误病例的临床结果和赔偿支付情况。
我们分析了通过国家日本医疗事故索赔数据库获取的 1961 年至 2017 年期间结案的诊断错误病例的特征。我们比较了诊断错误相关索赔（DERC）与非诊断错误相关索赔（非 DERC）在赔偿、临床结果和医生诊断错误的根本原因方面的差异。
共纳入 1802 例医疗事故索赔。患者年龄中位数为 33 岁（四分位间距= 10-54），男性占 54.2%。索赔中最常见的结果是死亡（939/1747；53.8%）。共有 709 例（39.3%，95%CI：37.0%-41.6%）DERC 病例。与非 DERC 病例相比，DERC 病例的总计费金额、接受率、调整后中位数索赔支付额和死亡比例显著更高。内科和外科部门发生 DERC 的可能性分别是其他科室的 1.42 倍和 1.55 倍。涉及急诊室（调整后的优势比[OR]=5.88）和门诊（调整后的 OR=2.87）的索赔更有可能是 DERC。最有可能导致诊断错误的初始诊断是上呼吸道感染、非出血性消化道疾病和“无异常”。
诊断错误病例导致严重的患者结局，并与高额赔偿有关。这些病例常发生于普通检查和急诊室以及内科和外科科室，最初被认为是常见的轻度疾病。
