Juntendo University, Department of General Medicine, Bunkyō, Tokyo, Japan.
Shimane University Hospital, General Medicine Center, Department of General Medicine, Izumo City, Shimane, Japan.
West J Emerg Med. 2023 Feb 20;24(2):340-347. doi: 10.5811/westjem.2022.11.55738.
Emergency departments (ED) are unpredictable and prone to diagnostic errors. In addition, non-emergency specialists often provide emergency care in Japan due to a lack of certified emergency specialists, making diagnostic errors and associated medical malpractice more likely. While several studies have investigated the medical malpractice related to diagnostic errors in EDs, only a few have focused on the conditions in Japan. This study examines diagnostic error-related medical malpractice lawsuits in Japanese EDs to understand how various factors contribute to diagnostic errors.
We retrospectively examined data on medical lawsuits from 1961-2017 to identify types of diagnostic errors and initial and final diagnoses from non-trauma and trauma cases.
We evaluated 108 cases, of which 74 (68.5%) were diagnostic error cases. Twenty-eight of the diagnostic errors were trauma-related (37.8%). In 86.5% of these diagnostic error cases, the relevant errors were categorized as either missed or diagnosed incorrectly; the others were attributable to diagnostic delay. Cognitive factors (including faulty perception, cognitive biases, and failed heuristics) were associated with 91.7% of errors. Intracranial hemorrhage was the most common final diagnosis of trauma-related errors (42.9%), and the most common initial diagnoses of non-trauma-related errors were upper respiratory tract infection (21.7%), non-bleeding digestive tract disease (15.2%), and primary headache (10.9%).
In this study, the first to examine medical malpractice errors in Japanese EDs, we found that such claims are often developed from initial diagnoses of common diseases, such as upper respiratory tract infection, non-hemorrhagic gastrointestinal diseases, and headaches.
急诊科（ED）变幻莫测，容易出现诊断错误。此外，由于缺乏认证的急诊专家，非急诊专家经常在日本提供急诊护理，这使得诊断错误和相关医疗事故更有可能发生。虽然有几项研究调查了急诊科与诊断错误相关的医疗事故，但只有少数研究关注日本的情况。本研究考察了日本急诊科与诊断错误相关的医疗事故诉讼，以了解各种因素如何导致诊断错误。
我们回顾性地检查了 1961 年至 2017 年的医疗诉讼数据，以确定非创伤和创伤病例的各种诊断错误类型以及初始和最终诊断。
我们评估了 108 例案例，其中 74 例（68.5%）为诊断错误案例。28 例诊断错误与创伤有关（37.8%）。在这些诊断错误案例中，86.5%的相关错误可归类为漏诊或误诊；其他则归因于诊断延误。认知因素（包括错误感知、认知偏差和失效启发式）与 91.7%的错误相关。创伤相关错误的最终诊断最常见的是颅内出血（42.9%），非创伤相关错误的初始诊断最常见的是上呼吸道感染（21.7%）、非出血性消化道疾病（15.2%）和原发性头痛（10.9%）。
在这项研究中，我们首次考察了日本急诊科的医疗事故错误，我们发现这些索赔通常源于上呼吸道感染、非出血性胃肠道疾病和头痛等常见疾病的初始诊断。
