Department of Internal Medicine, Rutgers New Jersey Medical School.
Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR.
J Clin Gastroenterol. 2022 Jan 1;56(1):49-54. doi: 10.1097/MCG.0000000000001471.
Over 14 million colonoscopies are performed annually, and this procedure remains the largest contributor to malpractice claims against gastroenterologists. The aim of this study was to evaluate reasons for litigation and predictors of case outcomes.
Cases related to colonoscopy were reviewed within the Westlaw legal database. Patient demographics, reasons for litigation, case payouts, and verdicts were assessed. Multivariate regression was used to determine predictors of defendant verdicts.
A total of 305 cases were included from years 1980 to 2017. Average patient age was 54.9 years (range, 4 to 93) and 52.8% of patients were female. Juries returned defendant and plaintiff verdicts in 51.8% and 25.2% of cases, respectively, and median payout was $995,000. Top reasons for litigation included delay in treatment (65.9%) and diagnosis (65.6%), procedural error (44.3%), and failure to refer (25.6%). Gastroenterologists were defendants in 71% of cases, followed by primary care (32.2%) and surgeons (14.8%). Cases citing informed consent predicted defendant verdict (odds ratio, 4.05; 95% confidence interval, 1.90-9.45) while medication error predicted plaintiff verdict (odds ratio, 0.18; 95% confidence interval, 0.04-0.59). Delay in diagnosis (P=0.060) and failure to refer (P=0.074) trended toward plaintiff verdict but did not reach significance. Most represented states were New York (21.0%), California (13.4%), Pennsylvania (13.1%), Massachusetts (12.5%).
Malpractice related to colonoscopy remains a significant and has geographic variability. Errors related to sedation predicted plaintiff verdict and may represent a target to reduce litigation. Primary care physicians and surgeons were frequently cited codefendants, underscoring the significance of interdisciplinary care for colonoscopy.
每年进行的结肠镜检查超过 1400 万次，该程序仍然是针对胃肠病学家的医疗事故索赔的最大贡献者。本研究的目的是评估诉讼的原因和案件结果的预测因素。
在 Westlaw 法律数据库中审查了与结肠镜检查相关的案例。评估了患者人口统计学特征、诉讼原因、案件支出和判决。使用多元回归来确定被告判决的预测因素。
共纳入了 1980 年至 2017 年的 305 例病例。患者平均年龄为 54.9 岁（范围为 4 至 93 岁），52.8%的患者为女性。陪审团分别对 51.8%和 25.2%的案件做出了被告和原告的判决，中位数支出为 99.5 万美元。诉讼的主要原因包括治疗延误（65.9%）和诊断延误（65.6%）、程序错误（44.3%）和未转介（25.6%）。胃肠病学家是 71%的案件的被告，其次是初级保健医生（32.2%）和外科医生（14.8%）。引用知情同意的案件预测了被告的判决（优势比，4.05；95%置信区间，1.90-9.45），而药物错误预测了原告的判决（优势比，0.18；95%置信区间，0.04-0.59）。诊断延迟（P=0.060）和未转介（P=0.074）倾向于原告的判决，但没有达到显著水平。代表人数最多的州是纽约州（21.0%）、加利福尼亚州（13.4%）、宾夕法尼亚州（13.1%）、马萨诸塞州（12.5%）。
与结肠镜检查相关的医疗事故仍然是一个重大问题，并且具有地域变异性。与镇静相关的错误预测了原告的判决，可能代表了减少诉讼的目标。初级保健医生和外科医生经常被列为共同被告，这突显了跨学科护理在结肠镜检查中的重要性。
