Týbbi uygulama hatasý iddiasý olan travmatik ölümlerde hekim sorumluluðunun belirlenmesinde travma skoru sistemlerinin kullanýlmasý

AMAÇ: Travmatik ölümler Dünya Saðlýk Örgütü’nün baþlýca ölüm sebepleri listesinde en üst sýralarda yer almaktadýr ve bu ölümlerde mortaliteyi en fazla etkileyen faktörlerden birisi travmanýn þiddetidir. Travma hastalarýnda týbbi giriþimler sýrasýnda kimi yaralanmalar atlanabilmekte ve bu durum týbbi uygulama hatasý iddialarýnýn doðmasýna neden olabilmektedir. Bu çalýþmanýn amacý, travma skorlama sistemlerinin saðlayacaðý yararý ortaya çýkarak týbbi uygulama hatasý iddiasý olan olgularýn deðerlendirilmesine yeni bir bakýþ açýsý getirmektir.
GEREÇ VE YÖNTEM: Olgulara Adli Týp Kurumu Genel Kurulu’nda 2010–2013 yýllarý arasýnda görüþülerek karara baðlanmýþ dosyalar taranarak ulaþýldý. Týbbi uygulama hatasý olan hekimin týbbi kayýtlarý, otopsi ya da son klinik deðerlendirme bulgularý göz önüne alýnarak her birisi için ayrý ayrý yaralanma aðýrlýk sorularý hesaplanarak karþýlaþtýrýldý.
BULGULAR: 2010–2013 yýllarý arasýnda 263 týbbi uygulama hatasý iddiasý dosyasý tartýþýlarak karara baðlanmýþtýr. Bunlardan 25’i hastanýn ölümüyle sonuçlanmýþ olgulardýr. Bu 25 olguda 34 hekim hakkýnda týbbi uygulama hatasý ile iddiasý ortaya atýþmýþtýr. Kurul 12 olguda 14 hekimin týbbi uygulama hatasý olduðu yönünde karar vermiþtir. Hakkýnda iddia olan hekimin tuttuðu týbbi kayýtlarda saptayabilmiþ olduðu travma bulgularý ile otopsi ya da son klinik deðerlendirmede saptanan tüm bulgulara ait Yaralanma Aðýrlýk Skoru ve Yeni-Yaralanma Aðýrlýk Skoru hesaplanarak atlanmýþ ya da gözden kaçýrýlmýþ yaralanmalarýn ölüm üzerindeki etkisi ortaya konabilecektir.
TARTIÞMA: Týbbi uygulama hatasý iddiasý bulunan olgularda travma skorlarýnýn hesaplanmasý tüm dallardan týbbi bilirkiþilikle görevlendirilmiþ uzmanlara ve ayrýca hakimlere, atlanmýþ ya da gözden kaçýrýlmýþ yaralanmalarýn etkilerinin ortaya çýkarýlmasýnda ve hekimin sorumluluðunun yorumlanmasýnda ve olgunun uygulama hatasý olmasaydý yaþayabilme ihtimalinin belirlenmesinde yardýmcý olacaktýr. Tek baþýna karar verdirici bir ölçüt olarak deðil diðer tüm bulgularý destekleyici bir araç olarak kullanýlabilecektir.

Use of trauma scoring systems to determine the physician’s responsibility in cases of traumatic death with medical malpractice claim

BACKGROUND: Traumatic injury is near the top of World Health Organization list of leading causes of death, and one of the major factors affecting mortality is the severity of the trauma. During medical intervention for trauma patients, some injuries may be overlooked, and this misstep may be the basis of a malpractice claim. The objective of this study was to provide a new approach to evaluating medical malpractice cases by discussing the benefits of the use of trauma scores.
METHODS: Cases of alleged malpractice that were discussed and concluded between 2010 and 2013 were selected from the case archive of the General Committee of the Council of Forensic Medicine (GC of CFM). Injury severity scores were calculated from the medical records of accused physicians and from the autopsy or final clinical evaluation records and compared.
RESULTS: Between the years 2010 and 2013, 263 cases of alleged medical malpractice were discussed and concluded by the general committee. Of these, in 25 cases of patient death, the reason for admission to the hospital was traumatic injury. Various surgical specialties were involved. In these 25 cases, 34 physicians were accused of medical malpractice, and the General Committee classified the interventions of 14 physicians in 12 cases as “malpractice.” Missed injuries and unrecognized diagnoses can be established by comparing the Injury Severity Score and New Injury Severity Score values in the findings of accused physicians with the subsequent findings of last evaluation or autopsy.
CONCLUSION: In a medical malpractice case, calculating injury severity scores may assist an expert witness or judge to detect any unseen injuries and to determine the likely survival potential of the patient, but these values do not provide enough information to evaluate all of the evidence or draw conclusions about the entire case. All contributing factors to trauma severity should be considered along with the trauma score and other case factors.