Legal risks in the work of a traumatologist associated with defects in the provision of emergency medical care
- Authors: Egiazaryan K.A.1,2, Lyadova M.V.1,2,3, Ershov D.S.1,2, Badriev D.A.1,2
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Affiliations:
- Pirogov Russian National Research Medical University
- Pirogov City Clinical Hospital No. 1
- Bureau of Forensic Medical Examination
- Issue: Vol 31, No 1 (2025)
- Pages: 7-17
- Section: Original Research Articles
- URL: https://journals.rcsi.science/0869-2106/article/view/292145
- DOI: https://doi.org/10.17816/medjrf634406
- ID: 292145
Cite item
Abstract
BACKGROUND: According to the literature, there is a steady increase in citizens' complaints about the quality of medical care.
AIM: The study aims to analyze the conclusions of forensic medical examinations of the most problematic groups of patients with acute injuries of the musculoskeletal system from the point of view of legal risk, to correlate adverse outcomes and common defects in medical care that are important in the legal assessment of the actions of a traumatologist, as well as to identify organizational measures to improve the quality of medical care.
METHODS: A sample analysis of 150 conclusions of the commission of forensic medical examinations was performed. All examinations were conducted in different expert institutions in Moscow and the Moscow region in the period from 2019–2023. A content analysis of regulatory legal documents regulating the activities in the provision of medical care to patients with an emergency injury has been performed. A correlation was made between the unfavorable outcome and the identified defects in the provision of medical care to patients with acute injuries. Due to the fact that these medical care defects are nominal, we have applied Pearson's χ2.
RESULTS: In the analysis of expert opinions, in most cases, defects in the provision of medical care were identified — 137 (91.3%), of which 47 (31.3%) conclusions contain 2 or more defects simultaneously. In 49 cases (32.7%), the expert assessment of the nature of the damage and the treatment plan was influenced by a defect in the management of medical records; in 38 cases (25.3%) — defects in treatment; in 27 cases (18.0%) — defects in diagnosis; in 19 cases (12.6%) — defects in the organization of medical care. Diagnostic defects related to missed fractures were detected in 18 (12.0%) cases. Most of the diagnostic defects were noted at the outpatient stage of medical care provision in a trauma center. Among the reasons for incorrect diagnosis, the following can be distinguished: inattentive examination of the victim, incorrect description of radiographs by a radiologist or a later description (for the next day or more), the inability to perform more high-tech and other research methods other than X-ray, for example, computed tomography or ultrasound.
CONCLUSION: In emergency traumatology, the probability of an adverse outcome is most affected by treatment defects (the relative risk was 1.21 with 25.3% of treatment defects — from 0.776 to 2.307). In the specialty "traumatology and orthopedics", there is a need to create scientifically sound, relevant to modern requirements of medical activity, clinical guidelines for patients with injuries of the musculoskeletal system, as well as to develop protocols for the provision of medical care to patients with polytrauma.
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##article.viewOnOriginalSite##About the authors
Karen A. Egiazaryan
Pirogov Russian National Research Medical University; Pirogov City Clinical Hospital No. 1
Email: egkar@mail.ru
ORCID iD: 0000-0002-6680-9334
SPIN-code: 5488-5307
MD, Dr. Sci. (Medicine), Professor
Russian Federation, Moscow; MoscowMaria V. Lyadova
Pirogov Russian National Research Medical University; Pirogov City Clinical Hospital No. 1; Bureau of Forensic Medical Examination
Email: mariadoc1@mail.ru
ORCID iD: 0000-0002-9214-5615
SPIN-code: 7636-6120
MD, Dr. Sci. (Medicine), Professor
Russian Federation, Moscow; Moscow; MoscowDmitry S. Ershov
Pirogov Russian National Research Medical University; Pirogov City Clinical Hospital No. 1
Email: ershov0808@gmail.com
ORCID iD: 0000-0001-7005-2752
SPIN-code: 9839-1206
MD, Cand. Sci. (Medicine)
Russian Federation, Moscow; MoscowDenis A. Badriev
Pirogov Russian National Research Medical University; Pirogov City Clinical Hospital No. 1
Author for correspondence.
Email: ill1dan@mail.ru
ORCID iD: 0000-0003-3497-5933
SPIN-code: 4884-4390
Russian Federation, Moscow; Moscow
References
- Semina TV. Socio-legal conflict between a patient and a doctor in society. Moscow: NCSSH im. A.N. Bakuleva; 2015. (In Russ).
- Spiridonov VA, Anisimov AA. Questions to experts when appointing a commission of forensic medical examinations based on adverse outcomes of medical care. Sudebno-medicinskaya ekspertiza. 2020;63(6):4–8. doi: 10.17116/sudmed2020630614 EDN: TQUVGT
- Shmarov LA. Analysis of forensic medical examinations — the reasons for the increase in the number of medical cases. Bulletin of Forensic Medicine. 2023;12(2):26–32. EDN: NVITHH
- Shapkin YG, Seliverstov PA. Phenomenon of mutual aggravation of injuries in polytrauma. Perm Medical Journal. 2016;33(5):82–94. doi: 10.18821/0023-2149-2016-94-5-346-352 EDN: WXHSGN
- Shmarov LA. Correlation of the results of forensic examinations with court decisions on claims against medical organizations. Sudebno-medicinskaya ekspertiza. 2020;63(3):8–12. doi: 10.17116/sudmed2020630318 EDN: QLXQKU
- Hromov AA, Gumanenko EK, Chapurin VA, Eskhan UH. The outcomes of surgical treatment of fractures of long tubular bones in patients with polytrauma. Modern Problems of Science and Education. 2016;(3):196–196. doi: 10.17513/spno.24867 EDN: WXJCHL
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