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Citation
Jimenez N, Posner KL, Domino KB, Cheney FW: "Trends in Pediatric Anesthesia Malpractice Claims over Three Decades." Anesthesiology 103: A1309, 2005.
Abstract
Introduction
Advances in pediatric anesthesia practice such as sub-specialization, introduction of new drugs and better monitoring may have changed the liability profile of pediatric anesthesia practice. Pediatric malpractice claims from the 1970s and early 1980s showed a high proportion related to respiratory complications (inadequate ventilation) with 45% of complications thought to be preventable.1 We analyzed 525 pediatric claims from the ASA Closed Claims database to identify patterns of injury and outcomes associated with pediatric anesthesia over three decades.
Methods
Standardized pediatric anesthesia claims (patients 16 yrs or younger) from the ASA Closed Claims Project database were analyzed. Claims involving neonatal complications of obstetric anesthesia or neonatal resuscitation were excluded, as were claims with unknown year of event. Logistic regression analysis was used to evaluate trends over time.
Results
Approximately half of claims involved patients 3 yrs or younger and approximately one quarter were ASA 3-5 (Table). The proportion of claims for death and permanent brain damage decreased over time (p=0.03, Table). The proportion of claims involving respiratory events also decreased over time (p<0.001, Table). The most common events leading to claims in the 1990s were cardiovascular (27%) and respiratory (25%), while equipment and medication problems accounted for nearly 1/3 of pediatric claims in the 1990s (Figure).[table1]Discussion: The decrease in claims for death and permanent brain damage and the reduction in respiratory events may be related to an increase in safety due to better monitoring, new drugs and sub-specialization. However, we cannot rule out if this trend is partly explained by an increase in claims for minor injuries due to changes in legal strategies or the relatively long statute of limitations for children.
Table
| 1970s | 1980-84 | 1985-89 | 1990-2000 | Total | ||
|---|---|---|---|---|---|---|
| # Cases | n=88 | n=161 | n=118 | n=153 | n=520 | |
| Age group | 0-3 yrs | 38 (43%) | 72 (45%) | 64 (54%) | 81 (53%) | 255 (49%) |
| ASA group | ASA 3-5 | 13 (16%) | 35 (24%) | 22 (20%) | 39 (27%) | 109 (23%) |
| Sex of patient | Female | 25 (30%) | 67 (42%) | 50 (43%) | 61 (41%) | 203 (40%) |
| Severity injury | Death/Perm BD* | 69 (78%) | 124 (77%) | 85 (72%) | 94 (61%) | 372 (72%) |
| Primary damaging event | Respiratory events† | 44 (57%) | 67 (48%) | 48 (46%) | 36 (25%) | 195 (42%) |
| CV events | 18 (23%) | 27 (19%) | 25 (24%) | 38 (27%) | 108 (23%) | |
| Equipment problems | 8 (10%) | 16 (11%) | 15 (14%) | 24 (17%) | 63 (14%) | |
| Medication related | 5 (6%) | 15 (11%) | 9 (9%) | 20 (14%) | 49 |
Missing data excluded; *p<0.05 over time periods (logistic regression); †p<0.001
Figure
References
- Anesthesiology 1993; 78:461-7.
A copy of the full text can be obtained from the American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573. Reprinted with permission of Lippincott Williams & Wilkins.