From the Departments of Radiology and Biomedical Imaging (A.K., M.K., S.B., S.P., C.M., J.M., A.M.).
Department of Radiology (X.W.), University of California at San Francisco, San Francisco, California.
AJNR Am J Neuroradiol. 2023 Apr;44(4):460-466. doi: 10.3174/ajnr.A7828. Epub 2023 Mar 30.
Approaches to management of intracranial aneurysms are inconsistent, in part due to apprehension relating to potential malpractice claims. The purpose of this article was to review the causes of action underlying medical malpractice lawsuits related to the diagnosis and management of intracranial aneurysms and to identify the factors associated and their outcomes.
We consulted 2 large legal databases in the United States to search for cases in which there were jury awards and settlements related to the diagnosis and management of patients with intracranial aneurysms in the United States. Files were screened to include only those cases in which the cause of action involved negligence in the diagnosis and management of a patient with an intracranial aneurysm.
Between 2000 and 2020, two hundred eighty-seven published case summaries were identified, of which 133 were eligible for inclusion in the analysis. Radiologists constituted 16% of 159 physicians sued in these lawsuits. Failure to diagnose was the most common medical malpractice claim referenced (100/133 cases), with the most common subgroups being "failure to include cerebral aneurysm as a differential and thus perform adequate work-up" (30 cases), and "failure to correctly interpret aneurysm evidence on CT or MR imaging" (16 cases). Only 6 of these 16 cases were adjudicated at trial, with 2 decided in favor of the plaintiff (awarded $4,000,000 and $43,000,000, respectively).
Incorrect interpretation of imaging is relatively infrequent as a cause of malpractice litigation compared with failure to diagnose aneurysms in the clinical setting by neurosurgeons, emergency physicians, and primary care providers.
颅内动脉瘤的治疗方法并不统一，部分原因是对潜在医疗事故索赔的担忧。本文的目的是回顾与颅内动脉瘤的诊断和治疗相关的医疗事故诉讼的诉讼理由，并确定相关因素及其结果。
我们在美国的两个大型法律数据库中进行了检索，以查找在美国与颅内动脉瘤患者的诊断和治疗相关的有陪审团裁决和和解的案例。筛选文件以仅包括那些诉讼理由涉及颅内动脉瘤患者的诊断和治疗中的疏忽的案例。
在 2000 年至 2020 年间，确定了 287 篇已发表的案例摘要，其中 133 篇符合纳入分析的条件。在这些诉讼中被起诉的 159 名医生中，放射科医生占 16%。未诊断出是被引用最多的医疗事故索赔（133 例中有 100 例），最常见的亚组是“未将脑动脉瘤作为鉴别诊断，因此未进行充分的检查”（30 例）和“未能正确解读 CT 或 MR 成像上的动脉瘤证据”（16 例）。在这 16 例中有 6 例在审判中进行了裁决，其中 2 例对原告有利（分别判给 400 万美元和 4300 万美元）。
与神经外科医生、急诊医生和初级保健提供者在临床环境中未能诊断出动脉瘤相比，影像学的错误解读相对较少成为医疗事故诉讼的原因。
