+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990-2015



Diagnostic errors in fatal medical malpractice cases in Shanghai, China: 1990-2015



Diagnostic Pathology 14(1): 8



Medical disputes remain unabated in China. Previous studies have shown the changes of diagnostic discrepancy over time in developed countries, but diagnostic discrepancy remains understudied in China, especially in the setting of medical disputes. We sought to describe the year-based changes of diagnostic discrepancies in medical disputes, and to identify factors associated with classes of diagnostic discrepancy. We conducted a retrospective cohort study of all medically disputed cases from 1990 through 2015 in Shanghai, China, with use of necropsy as the gold standard for diagnosis. Cases were grouped based on national legislative eras. Diagnostic discrepancy was classified as major errors (class I and II), minor errors (class III and IV), no discrepancy (class V) and undetermined (class VI) based on discrepancy severity. There were 482 medical disputes. Cases were predominantly males (male: female = 1.6:1) and concentrated in patients less than 10 years old or between 50 and 70 years. Major and minor discrepancy accounted for 51.7 and 34.8%, respectively. Fifty-five cases (11.2%) were non-discrepant (Class V). The dispute rate remained high before the first round of legislation (mean 0.31 per 1 million patients) but declined dramatically afterwards (R2 = - 0.82, p < 0.001 for time trends). Over the national legislative eras, the annual number of cases with diagnostic errors declined steadily. Incidence rates of discrepancy decreased significantly for class I (R2 = - 0.73, p = 0.024), II (R2 = - 0.48, p = 0.013), III (R2 = - 0.69, p < 0.0001), IV (R2 = - 0.69, p < 0.0001) and V discrepancy (R2 = - 0.58, p = 0.0018). Diseases from the respiratory system had significantly lower risks of any diagnostic errors (OR = 0.48, 95% 0.24-0.95, p = 0.036). A neoplasm carrier increased by 92% the risk of any diagnostic error (OR = 1.92; 95%CI 1.18-3.14; p = 0.009) and hypertension reduced by 78% the risk of minor errors (OR = 0.22, 95%CI 0.06-0.91, p = 0.036). Severity of discrepancy relieved over years and associated with ageing in patients with cardiovascular diseases (p = 0.01). The rate of fatal medical disputes and diagnostic discrepancy declined after stepwise legislations in China. Respiratory diseases, neoplasm carrier and hypertension could be independent predictors for assessing diagnostic errors.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 066446591

Download citation: RISBibTeXText

PMID: 30704492

DOI: 10.1186/s13000-019-0785-5


Related references

Medical malpractice cases and awards: 1980-1990. West Virginia Medical Journal 87(4): 147-147, 1991

Fatal cases of human infection with avian influenza A (H7N9) virus in Shanghai, China in 2013. Bioscience Trends 9(1): 73-78, 2015

Medical malpractice. Judgments of the Danish Medico-Legal Council in fatal cases. Journal of Forensic Sciences 16(2): 226-235, 1971

Medico-legal disputes. 14. Financial settlement in fatal cases due to diagnostic errors. Geka Chiryo. Surgical Therapy 25(5): 587-588, 1971

Epitome of China's unnatural deaths: a historically retrospective study of forensic autopsy cases in Shanghai Public Security Bureau from 1990 to 1999. American Journal of Forensic Medicine and Pathology 35(3): 218-221, 2014

Unintentional Poisoning in China, 1990 to 2015: The Global Burden of Disease Study 2015. American Journal of Public Health 107(8): 1311-1315, 2017

Claims, liabilities, injures and compensation payments of medical malpractice litigation cases in China from 1998 to 2011. Bmc Health Services Research 14: 390, 2014

Proceedings of the international symposium on ion channels and calcium antagonists (ISICCA). 1991 September 26-28 Shanghai Medical University, Shanghai, China. Abstracts. Zhongguo Yao Li Xue Bao 13(1): 72-96, 1992

Skin diseases in companion guinea pigs (Cavia porcellus): a retrospective study of 293 cases seen at the Veterinary Medical Teaching Hospital, University of California at Davis (1990-2015). Veterinary Dermatology 27(5): 395-E100, 2016

Interview -- medical malpractice --medical treatment errors: rehearsed behavior. Pneumologie 63(7): 361-362, 2009

Investigation of pathology malpractice claims in China from 2002-2015. Journal of Forensic and Legal Medicine 48: 30-34, 2017

The meteorological modulation on PM 2.5 interannual oscillation during 2013 to 2015 in Shanghai, China. Science of the Total Environment 572: 1138-1149, 2016

Medical Malpractice Claims Within Cardiology from 2006 to 2015. American Journal of Cardiology 123(1): 164-168, 2019

Estimates of CO2 emissions in Shanghai (China) in 1990 and 2010. Energy 22(10): 1015-1017, 1997

Fluoroquinolone Resistance Mechanisms in Shigella Isolates in Shanghai, China, Between 2010 and 2015. Microbial Drug Resistance 25(2): 212-218, 2019