Shimane University Faculty of Medicine, Shimane, Japan.
Postgraduate Clinical Training Center, Shimane University Hospital, Shimane, Japan; Master of Healthcare Quality and Safety Program, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2021 Apr;148:e35-e42. doi: 10.1016/j.wneu.2020.11.159. Epub 2020 Dec 5.
Neurosurgery is a specialty associated with high risk of malpractice claims, which can be influenced by quality and safety of care. Diagnostic errors have gained increasing attention as a potentially preventable problem. Despite the burden of diagnostic errors, few studies have analyzed diagnostic errors in neurosurgery. We aimed to delineate the effect of diagnostic errors on malpractice claims involving a neurosurgeon.
This retrospective study used the national Japanese malpractice claims database and included cases closed between 1961 and 2017. To examine the effect of diagnostic errors in neurosurgery, we compared diagnostic error-related claims (DERCs) with non-DERCs in indemnity, clinical outcomes, and factors relating to neurosurgeons.
There were 95 closed malpractice claims involving neurosurgeons during the study period. Of these claims, 36 (37.9%, 95% confidence interval [CI] 28.7%-47.9%) were DERCs. Patient death was the most common outcome associated with DERCs. Wrong, delayed, and missed diagnosis occurred in 25 (69.4%, 95% CI 53.1%-82.0%), 4 (11.1%, 95% CI 4.4%-25.3%), and 7 (19.4%, 95% CI 9.8%-35.0%) cases, respectively. The most common presenting medical condition in DERCs was stroke. Subarachnoid hemorrhage, accounting for 85.7% of stroke cases, led to 27.8% of the total indemnity paid in DERCs.
DERCs are associated with higher numbers of accepted claims and worse outcomes. Identifying diagnostic errors is important in neurosurgery, and countermeasures are required to reduce the burden on neurosurgeons and improve quality. This is the first study to focus on diagnostic errors in malpractice claims arising from neurosurgery.
神经外科是一个与医疗事故索赔风险较高相关的专业，其风险可能受到医疗质量和安全的影响。诊断错误作为一个潜在可预防的问题，已受到越来越多的关注。尽管诊断错误的负担沉重，但很少有研究分析神经外科的诊断错误。我们旨在描述诊断错误对涉及神经外科医生的医疗事故索赔的影响。
本回顾性研究使用了日本全国性的医疗事故索赔数据库，包括 1961 年至 2017 年期间结案的病例。为了研究神经外科中的诊断错误的影响，我们将与诊断错误相关的索赔（DERC）与非 DERC 进行了比较，比较了在赔偿、临床结果和与神经外科医生相关的因素方面的差异。
在研究期间，共有 95 起涉及神经外科医生的医疗事故索赔结案。在这些索赔中，36 起（37.9%，95%置信区间[CI] 28.7%-47.9%）为 DERC。患者死亡是与 DERC 相关的最常见结局。错误、延迟和漏诊分别发生在 25 例（69.4%，95% CI 53.1%-82.0%）、4 例（11.1%，95% CI 4.4%-25.3%）和 7 例（19.4%，95% CI 9.8%-35.0%）病例中。在 DERC 中最常见的表现疾病是中风。蛛网膜下腔出血占中风病例的 85.7%，导致 DERC 支付的总赔偿金的 27.8%。
DERC 与更多的索赔接受和更差的结果相关。在神经外科中识别诊断错误很重要，需要采取对策来减轻神经外科医生的负担并提高质量。这是第一项专门研究神经外科医疗事故索赔中诊断错误的研究。
