T�bbi uygulama hatas� iddias� olan travmatik �l�mlerde hekim sorumlulu�unun belirlenmesinde travma skoru sistemlerinin kullan�lmas�

Arslan, Murat Nihat; Kertmen, �isem; Melez, Deniz O�uzhan; Evc�man, Durmu�; B�y�k, Yal��n

Cilt : 23 Say� : 4 Y�l : 2024

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T�bbi uygulama hatas� iddias� olan travmatik �l�mlerde hekim sorumlulu�unun belirlenmesinde travma skoru sistemlerinin kullan�lmas� [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2017; 23(4): 328-336 | DOI: 10.5505/tjtes.2016.50540

T�bbi uygulama hatas� iddias� olan travmatik �l�mlerde hekim sorumlulu�unun belirlenmesinde travma skoru sistemlerinin kullan�lmas�

Murat Nihat Arslan¹, �isem Kertmen², Deniz O�uzhan Melez¹, Durmu� Evc�man³, Yal��n B�y�k⁴
¹Adli T�p Kurumu, Morg �htisas Dairesi, �stanbul, T�rkiye
²Adli T�p Kurumu, D�zce Adli T�p �ube M�d�rl��, D�zce, T�rkiye
³Adli T�p Kurumu, �anakkale Adli T�p �ube M�d�rl��, �anakkale, T�rkiye
⁴Adli T�p Kurumu, �stanbul, T�rkiye

AMA�: Travmatik �l�mler D�nya Sa�l�k �rg�t��n�n ba�l�ca �l�m sebepleri listesinde en �st s�ralarda yer almaktad�r ve bu �l�mlerde mortaliteyi en fazla etkileyen fakt�rlerden birisi travman�n �iddetidir. Travma hastalar�nda t�bbi giri�imler s�ras�nda kimi yaralanmalar atlanabilmekte ve bu durum t�bbi uygulama hatas� iddialar�n�n do�mas�na neden olabilmektedir. Bu �al��man�n amac�, travma skorlama sistemlerinin sa�layaca�� yarar� ortaya ��karak t�bbi uygulama hatas� iddias� olan olgular�n de�erlendirilmesine yeni bir bak�� a��s� getirmektir.
GERE� VE Y�NTEM: Olgulara Adli T�p Kurumu Genel Kurulu�nda 2010�2013 y�llar� aras�nda g�r��lerek karara ba�lanm�� dosyalar taranarak ula��ld�. T�bbi uygulama hatas� olan hekimin t�bbi kay�tlar�, otopsi ya da son klinik de�erlendirme bulgular� g�z �n�ne al�narak her birisi i�in ayr� ayr� yaralanma a��rl�k sorular� hesaplanarak kar��la�t�r�ld�.
BULGULAR: 2010�2013 y�llar� aras�nda 263 t�bbi uygulama hatas� iddias� dosyas� tart��larak karara ba�lanm��t�r. Bunlardan 25�i hastan�n �l�m�yle sonu�lanm�� olgulard�r. Bu 25 olguda 34 hekim hakk�nda t�bbi uygulama hatas� ile iddias� ortaya at��m��t�r. Kurul 12 olguda 14 hekimin t�bbi uygulama hatas� oldu�u y�n�nde karar vermi�tir. Hakk�nda iddia olan hekimin tuttu�u t�bbi kay�tlarda saptayabilmi� oldu�u travma bulgular� ile otopsi ya da son klinik de�erlendirmede saptanan t�m bulgulara ait Yaralanma A��rl�k Skoru ve Yeni-Yaralanma A��rl�k Skoru hesaplanarak atlanm�� ya da g�zden ka��r�lm�� yaralanmalar�n �l�m �zerindeki etkisi ortaya konabilecektir.
TARTI�MA: T�bbi uygulama hatas� iddias� bulunan olgularda travma skorlar�n�n hesaplanmas� t�m dallardan t�bbi bilirki�ilikle g�revlendirilmi� uzmanlara ve ayr�ca hakimlere, atlanm�� ya da g�zden ka��r�lm�� yaralanmalar�n etkilerinin ortaya ��kar�lmas�nda ve hekimin sorumlulu�unun yorumlanmas�nda ve olgunun uygulama hatas� olmasayd� ya�ayabilme ihtimalinin belirlenmesinde yard�mc� olacakt�r. Tek ba��na karar verdirici bir �l��t olarak de�il di�er t�m bulgular� destekleyici bir ara� olarak kullan�labilecektir.

Anahtar Kelimeler: G�zden ka��r�lm�� yaralanmalar, t�bbi uygulama hatas�, travmatik �l�mler, Yaralanma A��rl�k Skoru, Yeni-Yaralanma A��rl�k Skoru.

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

Murat Nihat Arslan¹, �isem Kertmen², Deniz O�uzhan Melez¹, Durmu� Evc�man³, Yal��n B�y�k⁴
¹Morgue Department, the Council of Forensic Medicine, �stanbul-Turkey
²D�zce Branch Office, the Council of Forensic Medicine, D�zce-Turkey
³�anakkale Branch Office, the Council of Forensic Medicine, �anakkale-Turkey
⁴The Council of Forensic Medicine, �stanbul-Turkey

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.

Keywords: Injury Severity Score, medical malpractice, missed injuries, New Injury Severity Score, traumatic deaths.

Sorumlu Yazar: Murat Nihat Arslan, T�rkiye
Makale Dili: �ngilizce

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