Engelhard SB, Collins M, Shah C, et al.
医疗事故 眼科 小儿
重要性：了解儿科医疗事故诉讼的结果让医生了解如何最好的照顾病人，防止这样的诉讼。目的：报告和分析涉及18岁以下患者的眼科医疗事故诉讼的原因和结果。设计、设置和参与者：综述了WestLaw数据库2015年4月1日至30日眼科相关的诉讼案件，包括1930年1月1日至2014年12月31日美国的定居点和审判裁决。检索条目包括检索到的文档中任意处的眼科或眼科医生和医疗事故。案件包括原告在煽动时间中不足18岁。比较儿科病例和成人病例。主要结果和措施：儿科医疗事故案件结果和结算金额。结果：本研究包括68例原告不足18岁的眼科医疗事故案件。55例（51.5%）经审判解决。与584例成年案件中168例相比，其中35例中，17例判决支持原告（差异，33%；95%可信区间，-24%到64%；P=0.1）。17例支持原告的裁决意味着陪审团奖金4815693美元（平均883281美元；范围147765-42061690美元）。68例中有9例（13.2%）导致结算，意味着调整赔偿1912738美元（平均1377689美元；范围92070-8493086美元）。剩下的24例（35.3%）涉及上诉裁决，预审和后审判救援裁决，1例判决。和成人案件相比，儿童案件评委会奖更高（差异3422134美元；95%可信区间-3422134至8731916美元；P=0.003）。法律上涉及失明的案件更有可能导致判决支持原告（差异60.5%；95%可信区间-1%至62%；P=0.3）。常见的临床诉讼场景是创伤性眼部损伤(15 [22.1%])，视网膜病变的早期(12 [17.6%])和眼内炎(6 [8.8%])。结论和相关性：涉及儿科患者的医疗事故诉讼更有可能支持原告，解决时比成人诉讼需要更高的货币补偿。涉及视网膜早期病变的案件导致给予原告最高支付赔偿，失明和/或眼内炎案件的解决更有可能支持原告。这些信息可能会让小儿眼科医生了解常见的导致诉讼的情况。
Importance:Understanding outcomes of pediatric malpractice litigation allows ophthalmologists to gain insight into how to best care for patients and prevent such litigation.Objectives:To report and analyze the causes and outcomes of ophthalmology medical malpractice litigation involving patients younger than 18 years.Design, Setting, and Participants:The WestLaw database was reviewed from April 1 to 30, 2015, for ophthalmology-related lawsuits, including settlements and trial verdicts, in the United States from January 1, 1930, to December 31, 2014. Search terms included ophthalmology or ophthalmologist and malpractice anywhere in the retrieved documents. Cases in which the plaintiffs were younger than 18 years at the time of the inciting event were included. Pediatric cases were compared with adult cases.Main Outcomes and Measures:Pediatric malpractice case outcomes and settlement amounts.Results:Sixty-eight ophthalmology malpractice cases involving plaintiffs younger than 18 years were included in the study. Thirty-five cases (51.5%) were resolved via jury trial. Of these 35 cases, verdicts in favor of the plaintiff were issued in 17 pediatric cases (48.6%), compared with 168 of 584 adult cases (28.8%) (difference, 33%; 95% CI, -24% to 64%; P=.01). The 17 cases that resulted in verdicts in favor of the pediatric plaintiff had a mean jury award of $4815693 (median, $883281; range, $147765-$42061690). Nine of the total 68 cases (13.2%) resulted in a settlement, with mean adjusted indemnities of $1912738 (median, $1377689; range, $92070-$8493086). The remaining 24 cases (35.3%) involved appellate rulings, pretrial and posttrial relief rulings, and 1 bench verdict. Jury awards were higher in pediatric vs adult cases (difference, $3422134; 95% CI, -$3422134 to $8731916; P=.002), as were indemnity payments (difference, $1186757; 95% CI, -$69074 to $3342588; P=.003). Cases involving legal blindness were more likely to result in verdicts in favor of the plaintiff (difference, 60.5%; 95% CI, -1% to 62%; P=.30). Common clinical scenarios in cases of litigation were traumatic ocular injury (15 [22.1%]), retinopathy of prematurity (12 [17.6%]), and endophthalmitis (6 [8.8%]).Conclusions and Relevance:Malpractice litigation involving pediatric patients was more likely to be resolved in favor of the plaintiff and was associated with higher monetary awards than was adult litigation. Cases involving retinopathy of prematurity resulted in the highest payments to plaintiffs, and cases involving legal blindness and/or endophthalmitis were more likely to be resolved in favor of the plaintiff. This information may give pediatric ophthalmologists insight into the situations and conditions that commonly lead to litigation.