1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota.
2University of Minnesota Law School, Minneapolis, Minnesota.
Neurosurg Focus. 2020 Nov;49(5):E17. doi: 10.3171/2020.8.FOCUS20607.
Current guidelines do not specify timing for management of acute spinal cord injury (aSCI) due to lack of high-quality evidence supporting specific intervals for intervention. Randomized prospective trials may be unethical. Nonetheless, physicians have been sued for delays in diagnosis and intervention.
The authors reviewed both the medical literature supporting the guidelines and the legal cases reported in the Westlaw and Lexis Advance databases from 1972 to 2018 resulting in awards or settlements, to identify whether surgeons are vulnerable to litigation despite the existence of guidelines not mandating specific timing of care.
Timing of intervention was related to claims in 59 (36%) of 163 cases involving SCI. All 22 trauma cases identified cited timing of intervention, sometimes related to delayed diagnosis, as a reason for the lawsuit. The mean award of 10 cases in which the plaintiffs' awards were disclosed was $4,294,384. In the majority of cases, award amounts were not disclosed.
Because conduct of a prospective, randomized trial to investigate surgical timing of intervention for aSCI may not be achievable, evidence-based guidelines will be unlikely to mandate specific timing. Nonetheless, surgeons who unreasonably delay intervention for aSCI may be at risk for litigation due to treatment delay. This is increasingly likely in an environment where "complete" SCI is difficult to verify. SCI may at some point be recognized as a surgical emergency, as brain injury generally is, despite a lack of prospective randomized trials supporting this implementation, challenging the feasibility of the US trauma infrastructure to provide care for these patients.
由于缺乏支持干预特定时间间隔的高质量证据，目前的指南并未具体规定急性脊髓损伤（aSCI）的管理时机。随机前瞻性试验可能不道德。尽管如此，仍有医生因诊断和干预延迟而被起诉。
作者审查了支持指南的医学文献和 1972 年至 2018 年在 Westlaw 和 Lexis Advance 数据库中报告的导致裁决或和解的西方法律案件，以确定尽管存在不要求特定护理时间的指南，外科医生是否仍容易受到诉讼。
干预时机与涉及 SCI 的 163 例病例中的 59 例（36％）索赔有关。确定的 22 例创伤病例均引用了干预时机，有时与延迟诊断有关，作为诉讼的原因。在公开了原告裁决的 10 个案例中，平均裁决额为 4,294,384 美元。在大多数情况下，裁决金额未公开。
由于进行调查 aSCI 手术干预时机的前瞻性、随机试验可能无法实现，基于证据的指南不太可能要求特定的时机。尽管如此，由于治疗延迟，不合理延迟 aSCI 干预的外科医生可能面临诉讼风险。在“完全”SCI 难以验证的情况下，这种情况越来越有可能发生。尽管缺乏支持这一实施的前瞻性随机试验，但 SCI 可能会被视为一种手术急症，就像脑损伤一般，这对美国创伤基础设施为这些患者提供护理的可行性构成了挑战。
