Legal risks in the work of a traumatologist associated with defects in the provision of emergency medical care

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.