[현재위치]: 홈> 진료과목별 분류> 응급의학> 소아 응급환자의 의료사고

소아 응급환자의 의료사고

• Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.   Pediatr Emerg Care. 2005 Mar;21(3):165-9.

  • 질환별 빈도(빈도별 순서)

    1. 뇌수막염

    2. 충수염

    3. 위팔뼈 골절(상박골 골절)

    4. 아래팔뼈 골절(노뼈 혹은 자뼈 골절, 요골 혹은 척골 골절)

    5. 고환꼬임(고환염전, testicular torsion)

    6. 넙다리뼈 골절(대퇴골 골절)

    7. 아랫다리뼈 골절(정강뼈 혹은 종아리뼈 골절, 경골 혹은 비골 골절)

    8. 신생아 신경학적 손상(neurologically impaired newborn)

    9. 배와 골반부위와 관련된 기타 증상(other symptoms involving the abdomen and pelvis)

    10. 폐렴

  • 나이별 질환의 분포

    • 	First	Second	Third
      0-2세	뇌수막염	신생아 신경학적 손상	폐렴
      3-5세	골절	뇌수막염	충수염
      6-11세	골절	충수염	뇌수막염
      12-17세	골절	충수염	고환꼬임

  • 10대 과실유형

    • 	손해배상 청구 건수(Number of claims) N=2132	전체 건수에서의 비율
      진단과실(Diagnostic error)	832	39
      과실 없음(No medical error)	391	18
      시술의 술기부족(Improper performance of procedure)	386	18
      감독과실(failure to supervise other staff)	120	6
      응급처치 혹은 시술의 미시행(Resuscitation/procedure not done)	95	4
      치료지연(Delay in treatment)	84	4
      투약과실(Medication error)	63	3
      입원적응의 퇴원조치(failure to admit to hospital)	57	3
      협진 혹은 전원과실	53	3
      부적정한 처치(failure to respond appropriately)	51	2

  • 손해배상 청구의 결과

    • 결과	비율(%)
      소송 시작 후 화해(settled after litigation began)	47
      소송 시작 전 화해(settled before litigation began)	29
      취하(case dropped)	9
      기각(settled by court)	7(dismissed by action of court)
      원고패소(judgment for defendant)	6
      원고승소(judgment for plaintiff)	1
      중재(mediation)	1

• 소아의 무릎손상 진단 Performance of a decision rule for radiographs of pediatric knee injuries.

  • Although decision rules for radiographs of pediatric knee injuries have been suggested from retrospective studies, prospective evaluations of such rules have been limited.

  • We sought to prospectively assess the performance of a rule in children presenting with acute knee injuries. Eligible participants were children aged 3-18 years with an acute knee injury.

  • The settings for the study were a tertiary pediatric emergency department (ED), a community hospital ED, and a pediatric urgent care center.

  • All of the participants received standard knee radiographs.

  • 신체검사 (Before radiography, each patient was assessed by a pediatrician or pediatric emergency physician for presence of the following)

    • 1) 체중지탱 불가(inability to bear weight)

    • 2) 무릎의 90도 구부림 불가(inability to flex the knee to 90 degrees)

    • 3) 압통(presence of bony tenderness)

  • The radiographs were interpreted by a radiologist blinded to the study; those with findings reported as consistent with acute fracture were considered positive.

  • A total of 146 patients were enrolled (65% male, mean age 11.6 years).

    • Of these, 15 (10.3%) had a fracture on their radiograph, 6 of which were related to trampoline use.

    • Seventy-seven (53%) were negative for criterion 1 (i.e., able to bear weight immediately after the accident and in the ED), none (0%) of whom had fractures.

      • The negative predictive value of this criterion was 1.0 (95% CI 0.94-1.0).

      • The positive predictive value was 0.22 (95% CI 0.13-0.34).

      • The sensitivity was 1.0 (95% CI 0.82-1.0).

      • The specificity was 0.59 (95% CI 0.50-0.67).

    • Three patients negative for criterion 3 were found to have fractures.

    • The proximal tibia was the most common fracture site (47%).

    • In conclusion, assessment of the ability to bear weight would have decreased the use of radiography by 53% without missing any fractures in our study population. No additional value to the rule was found by adding assessment of the ability to flex the knee or bony tenderness.

  • J Emerg Med.  2005; 28(3):257-61 

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