No abstract

Although the Abbreviated Injury Scale (AIS) is the most widely used severity scoring system for traumatic injuries, hospitals are required to document and bill based on the International Classification of Diseases (ICD). An expert panel recently developed a map between ICD-9-CM and ICD-10-CM to AIS 2005 Update 2008. This study aimed to validate the recently developed map using a large trauma registry. The map demonstrated moderate to substantial agreement for maximum AIS (MAIS) scores per body region based on expert chart review versus map-derived values (range: 44%-86%). Injury Severity Scores (ISSs) calculated from expert coders versus map-derived values were also compared and demonstrated moderate agreement (ICD-9-CM: 48%, ICD-10-CM: 54%). Although not a perfect conversion tool, the new ICD-AIS map provides a systematic method to assign injury severity for datasets with only ICD-9-CM and ICD-10-CM codes available and can be used for future injury-related research and data analysis.

In Lyme disease endemic areas, synovial fluid WBC counts cannot always help differentiate septic from Lyme arthritis. Rapid Lyme diagnostics could help avoid unnecessary operative procedures in patients with Lyme arthritis.

Objectives: This study aimed to provide an assessment of medical malpractice claims involving pediatric patients cared for in emergency department and urgent care settings. Methods:We performed a retrospective review of all closed malpractice claims involving children (0-17 years old) originating from emergency department or urgent care centers from the Physician Insurers Association of America's Data Sharing Project database for a 15-year period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015). Reported data collected include medical specialty involved, medical diagnoses, chief medical factors, severity of resulting injury, claim disposition, average indemnity, and average defense costs.Results: A total of 728 closed claims in pediatric emergency care settings were reviewed. Money was paid to the claimant in 30% of cases (220/728), with a total of US $70.3 million (average $319,513) paid to patients or families during the 15-year period. The most common resulting medical conditions were cardiac or cardiorespiratory arrest, appendicitis, and disorder of male genital organs. Error in diagnosis was the most common chief medical factor (41%), whereas those that involved failure or delay in admission to the hospital, which was the eighth most common chief medical factor, resulted in the highest average indemnity. Of the 728 closed claims, 220 involved a patient death (30%), but claims involving major permanent injury more often resulted in a payment. Of the 57 cases that went to trial, verdicts favored the physician in 47 cases (82%).Conclusions: Cardiac conditions, appendicitis, and disorder of the male genital organs are the most common medical conditions, and error in diagnosis is the most common chief medical factor in pediatric emergency care malpractice suits. It is important for providers practicing in these settings to be familiar with the common diagnoses and chief medical factors involved in these claims.