A review of reported litigation against English health trusts for the treatment of children in orthopaedics: Present trends and suggestions to reduce mistakes

Abstract

Purpose Large scale databases that offer a reflection of clinical negligence are rare. By assessing commonly occuring cases of negligence, we hope to highlight areas where pediatric orthopedic care might be improved. One such database is the National Health Service Litigation Authority, which deals with claims brought against all health trusts in England. By collating their data we aimed to highlight areas of commonly occurring clinical negligence and then suggest ways to avoid similar happening again. Method We reviewed all cases pertaining to pediatric orthopedic claims between 1995 to 2006 as provided by the NHSLA. Results Of those considered in our study (341), by far the most common cause of litigation is missed or incorrectly diagnosed injuries/ conditions-accounting for 57% of all cases. 44% of those are upper limb injuries, mainly fractures around the elbow. Misdiagnosed disorders of the hip such as hip dysplasia and SCFE also represent a frequent reason for litigation (11%). Other common causes are poor plaster application and removal (7.3%) and non-surgical site specific errors such as chemical burns from skin prep. Conclusion Although specific to the English system, these findings are likely to mirror that found in other countries. Highlighting these commonly occurring errors, better education of doctors in targeted areas and due care in simple procedures may have significant improvement of child orthopedic care.

Delayed diagnosis in primary care-The main cause of sarcoma litigation in the United Kingdom

“…In our study, we found that 89% of cases of proven negligence were due to delayed diagnosis in some form or another. This follows observed trends in current published literature, where misdiagnosis or a delay in diagnosis are the most frequent sources of litigation in orthopaedic surgery [8]. Poor awareness and knowledge of lumps will no doubt influence patient outcome and survival, resulting in false reassurances, inappropriate treatments and late referrals.…”

Twenty years experience of selective secondary ultrasound screening for congenital dislocation of the hip

“…Atrey's study31 published a rate of just 2.4 cases per year of litigation for DDH, however this is not consistent with the senior author's personal experience of exposure to 10 cases per year. Calculations are based on an estimate that 50 cases per year will progress to legal action in the UK, and therefore, an estimated 50% of late presentations will result in resolved legal action with the average cost of £48 534 (2010 currency).…”

“… Cost framework derived from Clegg et al 12 and Atrey et al 31. All costs are inclusive of inpatient stay, theatre time, staff time, investigations and materials used.…”

Traumatic Pediatric Olecranon Injury

“…7 ''The radiographic appearance seemed harmless'' lesions around the elbow joint are often underappreciated resulting in malunion 8 and are a leading cause of litigation claims in the United Kingdom. 9 The olecranon epiphyseal fractures are rare; 80% of these injuries do not warrant surgical intervention and can be managed by immobilization. 10 The reported incidence of associated other bony injuries around the elbow joint after these olecranon inju-ries varies from 14% to 77%, 1,11Y14 and the awareness of pitfalls in the initial diagnosis of the injuries is necessary for prompt diagnosis.…”