Written by Clay Smith
In the pediatric ED setting, respect cardiac issues, abdominal pain (missed appendicitis), and testicular pain (torsion). Generally, erring on the side of admission is safer from a malpractice standpoint.
Why does this matter?
In adults, chest pain, missed fractures, and appendicitis top the list for reasons why emergency physicians get sued. What about in the pediatric ED?
Learning how to not get sued
This was a retrospective review of 728 closed malpractice claims involving pediatric emergency settings over a 15 year span from a large malpractice insurer database. Of these, 30% had claims paid, averaging $319,513 for each claim ($70M total). The most common medical issues leading to suits were, “cardiac or cardiorespiratory arrest, appendicitis, and disorder of male genital organs.” Missed meningitis, encephalopathy, and missed fractures were also high on the list. Error in diagnosis was the most common medical factor leading to a suit. However, delay or failure to admit to the hospital was the error leading to the highest payouts. Of the 728 closed claims, 457 (63%) were ultimately dropped; 25% settled; just 1.4% received a verdict for the plaintiff. Only 57 of the cases went to trial. Of these, 47 (82%) favored the physician, which surprised me. My take home is to respect cardiac issues, abdominal pain, and testicular torsion in pediatric patients. When you are on the fence about an admission, think carefully. Risk lies on the side of discharging home, from a malpractice perspective.
Pediatric Malpractice Claims in the Emergency Department and Urgent Care Settings From 2001 to 2015. Pediatr Emerg Care. 2021 Jul 1;37(7):e376-e379. doi: 10.1097/PEC.0000000000001602.