Epidemiology of medico-legal litigations and related medical errors in Central and Northern Saudi Arabia. A retrospective prevalence study.

OBJECTIVE: To study medico-legal litigations and related medical errors in Central (Al-Qassim), and Northern (Hael) districts in the Kingdom of Saudi Arabia (KSA), and to identify types and causes of errors to reduce medical errors and patient harm. METHODS: This retrospective prevalence study was carried out between May 2010 and December 2011 to analyze medico-legal litigations in Al-Qassim and Hael districts that were investigated by the Al-Qassim Medico-Legal Committee, Al-Qassim, KSA. Final verdicts issued between 1992 and 2009 included 293 cases. RESULTS: The patient`s mean age was 29.5 years. Fifty-seven percent of the patients were females, and 92% were Saudis. The Obstetric and Gynecology department was involved in 29.7% of litigations followed by General Surgery, and Pediatrics (11.3% each). Of the 635 defendants, 90% were physicians, and 7.6% were nurses. Investigations showed no error in 47.1% of cases, error but no harm in 11.9%, and error resulted in harm in 39.6%. Errors were negligence (45.8%), wrong diagnosis (14.2%), surgical error (10.3%), and administrative error (5.2%). The average total duration of litigations was 13.9 months. Type of harm was the most significant predictor to determine a guilty decision (p<0.001). CONCLUSION: Obstetric practice in Al-Qassim and Hael districts and provider negligence contribute to a large portion of medico-legal litigations, and therefore this has to be further studied to recognize the specific causes and possible interventions. A systematic review of the medico-legal committee is needed to shorten the long duration of litigation.

The influence of age on the morbidity and mortality of pedestrian victims.

OBJECTIVES: The present study examined the influence of age on the morbidity and mortality of pedestrian victims while controlling for confounding factors. METHODS: The Pedestrian Crash Data Study (PCDS) database was used for a cross-sectional study to compare the outcome of senior (age >or=60 years) and adult (age 19 to 50 years) pedestrian victims. The outcome measures were the Injury Severity Score (ISS), Maximum Abbreviated Injury Score (MAIS), Abbreviated Injury Scale (AIS), and Mortality. Logistic regression models were used to estimate age-associated risks while controlling for confounders such as vehicle type, impact speed, and pedestrian height, weight, and gender. RESULTS: Compared to the adult victims, the seniors had a higher average ISS (23 vs. 16, p = 0.018) and higher mortality (30 percent vs. 11 percent, p or=9 (odds ratio = 2.72; 95 percent CI: 1.31-5.68) and to die (odds ratio = 6.68; 95 percent CI: 2.37-19.88). The seniors were approximately twice as likely to have higher AIS scores to almost every body region. CONCLUSIONS: The adjusted age-dependent risks indicated by the current study should be considered when calculating or projecting pedestrian morbidity and mortality. Adjustment in statistical models is essential to achieve precise risk estimates and in turn to appropriately allocate public health rescores.

Child and adult pedestrian impact: the influence of vehicle type on injury severity.

In the United States, the vehicle fleet is shifting from predominantly passenger cars (automobiles) to SUVs, light trucks, and vans (LTV). This study investigates how pedestrian severe injury and mortality are associated with vehicle type and pedestrian age. The Pedestrian Crash Data Study (PCDS) database for years 1994-1998 was used for a cross-sectional study design. Outcome measures were Injury Severity Score, Maximum Abbreviated Injury Score, Abbreviated Injury Scale, Pedestrian Mortality, Functional Capacity Index and Life Years Lost to Injury. Compared to children, adult pedestrians were more likely to sustain severe injury (OR = 2.81; 95% CI: 1.56-5.06) or mortality (OR = 2.91; 95% CI: 1.10-7.74) when examining all vehicle types. However, after adjusting for vehicle type and impact speed, this association was not statistically significant at p < 0.05. Compared to passenger cars, pedestrians struck by LTV were more likely to have severe injuries (OR = 1.31; 95% CI: 0.88-1.94) or mortality (OR = 1.40; 95% CI: 0.84-2.34) for all pedestrians. Adjusting for pedestrian age, this association was more obvious and significant at lower impact speeds ( < or = 30 km/h); odds ratios of severe injury and mortality were 3.34 (p< 0.01) and 1.87 (p= 0.07), respectively. Adults hit by LTV had the highest risk of injury and mortality. These findings indicate that pedestrian age, vehicle engineering design and impact speed are highly contributing to risks of pedestrian injury and mortality.