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Litigation risks despite guideline adherence for acute spinal cord injury: time is spine. | LitMetric

AI Article Synopsis

  • Current guidelines for managing acute spinal cord injury (aSCI) lack specific timing recommendations due to insufficient high-quality evidence, leading to potential legal issues for physicians who face lawsuits from delays in diagnosis and treatment.
  • A review of legal cases showed that in 36% of 163 cases involving spinal cord injuries, timing of intervention was a key factor, with trauma cases frequently citing delays as a reason for lawsuits and resulting in substantial financial awards.
  • Without the possibility of effective randomized trials, establishing evidence-based guidelines for the timing of aSCI intervention remains challenging, yet surgeons may face litigation risks for unreasonable delays, particularly as spinal cord injuries could be recognized as surgical emergencies in the future.

Article Abstract

Objective: Current guidelines do not specify timing for management of acute spinal cord injury (aSCI) due to lack of high-quality evidence supporting specific intervals for intervention. Randomized prospective trials may be unethical. Nonetheless, physicians have been sued for delays in diagnosis and intervention.

Methods: The authors reviewed both the medical literature supporting the guidelines and the legal cases reported in the Westlaw and Lexis Advance databases from 1972 to 2018 resulting in awards or settlements, to identify whether surgeons are vulnerable to litigation despite the existence of guidelines not mandating specific timing of care.

Results: Timing of intervention was related to claims in 59 (36%) of 163 cases involving SCI. All 22 trauma cases identified cited timing of intervention, sometimes related to delayed diagnosis, as a reason for the lawsuit. The mean award of 10 cases in which the plaintiffs' awards were disclosed was $4,294,384. In the majority of cases, award amounts were not disclosed.

Conclusions: Because conduct of a prospective, randomized trial to investigate surgical timing of intervention for aSCI may not be achievable, evidence-based guidelines will be unlikely to mandate specific timing. Nonetheless, surgeons who unreasonably delay intervention for aSCI may be at risk for litigation due to treatment delay. This is increasingly likely in an environment where "complete" SCI is difficult to verify. SCI may at some point be recognized as a surgical emergency, as brain injury generally is, despite a lack of prospective randomized trials supporting this implementation, challenging the feasibility of the US trauma infrastructure to provide care for these patients.

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Source
http://dx.doi.org/10.3171/2020.8.FOCUS20607DOI Listing

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