Claims for compensation after injuries related to airway management: a nationwide study covering 15 years.

BACKGROUND: Securing the airway is one of the most important responsibilities in anaesthesia. Injuries related to airway management can occur. Analysis from closed claims can help to identify patterns of injury, risk factors and areas for improvement. METHODS: All claims to The Norwegian System of Compensation to Patients from 1 January 2001 to 31 December 2015 within the medical specialty of anaesthesiology were studied. Data were extracted from this database for patients and coded by airway management procedures. RESULTS: Of 400 claims for injuries related to airway management, 359 were classified as 'non-severe' and 41 as 'severe'. Of the severe cases, 37% of injuries occurred during emergency procedures. Eighty-one claims resulted in compensation, and 319 were rejected. A total of €1,505,344 was paid to the claimants during the period. Claims of dental damage contributed to a numerically important, but financially modest, proportion of claims. More than half of the severe cases were caused by failed intubation or a misplaced endotracheal tube. CONCLUSION: Anaesthesia procedures are not without risk, and injuries can occur when securing the airway. The most common injury was dental trauma. Clear patterns of airway management that resulted in injuries are not apparent from our data, but 37% of severe cases were related to emergency procedures which suggest the need for additional vigilance. Guidelines for difficult intubation situations are well established, but adherence to such guidelines varies. Good planning of every general anaesthesia should involve consideration of possible airway problems and assessment of pre-existing poor dentition.

Traumatic dental injury.

BACKGROUND: The aim of this study was to retrospectively evaluate the incidence of traumatic dental injury and consequential dental impairment following road traffic accidents and to examine the factors that can affect the monetary value of compensation for bodily injury payable pursuant to current insurance regulations. METHODS: From 2004 to 2014, 7233 persons involved in road traffic accidents in the province of Messina, eastern Sicily, were examined by insurance physicians to assess bodily injury damage. Data were collected from cases of traumatic dental injury causing malocclusion and temporomandibular joint dysfunction, either alone or concomitant with injuries to other parts of the body. Injury characteristics and consequential bodily injury damage were classified and the incidence calculated using Microsoft Excel software. RESULTS: The incidence of traumatic dental injuries was 3% of the total population (195 subjects - 127 males and 68 females); the majority of cases (56%) involved riders of two-wheeled vehicles. A high percentage of riders received injury to one or more teeth, i.e. fractures and dislocations, more frequently to the anterior teeth (68%) than the posterior teeth because of their position in the dental arch. Temporomandibular joint injuries were far fewer (8%) and resulted from either direct or indirect trauma associated with severe head and/or neck injury. The incidence of permanent bodily damage consequential to these injuries was fairly low. CONCLUSIONS: Although the incidence of dental trauma following road traffic accidents is low, the monetary compensation for consequential dental impairment based on current insurance regulatory law is far from negligible.

A Novel Approach for the Reimbursement of Permanent Partial Dental Disability Following Dental Injury.

Reimbursement of long-term permanent disability following a dental injury can lead to claims and legal involvement by the injured person. This will delay the treatment the patient's quality of life and the court system. A new formula has been hypothesized to address the problem. This might help the stakeholders including patients, insurance companies. The details of calculating the index and its significance are discussed. Implication studies are mandatory to refine the proposed hypothesis.

Absence of an association between socioeconomic indicators and traumatic dental injury: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to perform a systematic review and search for scientific evidence on the association between socioeconomic indicators and traumatic dental injury (TDI) in the primary dentition. METHODOLOGY: The PubMed, ISI, LILACS, Cochrane Library, and Embase databases were searched for articles addressing possible associations between socioeconomic indicators and TDI in the primary teeth in journals dating from the inception of the databases through to December 2013. Two independent reviewers performed data extraction and analyzed the quality of the studies. Meta-analysis was undertaken. Pooled estimates were calculated with a 95% confidence interval (CI) and odds ratios (OR). RESULTS: Sixteen articles were included in the systematic review. Children from families with household income less than two times average salary (U$ 592) (OR: 0.77; 95% CI: 0.66-0.90) or more than three times the average salary (U$ 888) (OR: 0.76; 95% CI: 0.65-0.89) had a significantly lower chance of having TDI in the primary dentition. TDI was not associated with socioeconomic status (high vs low - OR: 0.77; 95% CI: 0.43-1.36; high vs medium - OR: 1.03; 95% CI: 0.72-1.48; medium vs low - OR: 0.70; 95% CI: 0.42-1.19), house ownership (owned vs rented - OR: 1.28; 95% CI: 0.98-1.66), mother's schooling (OR: 0.89; 95% CI: 0.74-1.08), or father's schooling (OR: 1.01; 95% CI: 0.62-2.74). CONCLUSION: The scientific evidence demonstrates that socioeconomic indicators are not associated with TDI in the primary dentition. The evidence of an association between a low income and TDI is weak. In general, studies had low risk of bias. Further prospective cohort studies are needed to confirm this association.

Summary of: A study of factors that influence the number of visits following traumatic dental injuries.

OBJECTIVE: To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. METHOD: A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. RESULTS: 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). CONCLUSION Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

A study of factors that influence the number of visits following traumatic dental injuries.

OBJECTIVE: To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. METHOD: A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. RESULTS: 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). CONCLUSION: Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.

Epidemiology of traumatic dental injuries.

The oral region comprises 1% of the total body area, yet it accounts for 5% of all bodily injuries. In preschool children, oral injuries make up as much as 17% of all bodily injuries. The incidence of traumatic dental injuries is 1%-3%, and the prevalence is steady at 20%-30%. The annual cost of treatment is US $2-$5 million per 1 million inhabitants. Etiologic factors vary between countries and with age groups. Important public health implications such as how to best organize emergency dental care and how to prevent dental injuries, decrease cost, and increase lay knowledge are important factors needed to change epidemiologic data toward more favorable figures in the future.

Traumatic dental injury and social deprivation in five-year-old children in Scotland 1993-2007.

OBJECTIVE: To describe the pattern and time trends of dental injury and its sociodemographic determinants among five-year-old children in Scotland. DESIGN AND METHODS: A retrospective analysis of Scottish Health Boards' Dental Epidemiological Programme (SHBDEP) and National Dental Inspection Programme (NDIP) records for the period 1993-2007. Annual incidences were calculated by age, gender, health board and deprivation categories (DEPCAT). RESULTS: Out of 68,354 children examined only 405 (0.6%) had suffered dental injury with an overall incidence of 5.9/1000 population. There was a remarkable decrease in incidence over time. Virtually the same rates were recorded for the two genders (M:F = 1.13:1.0). The incidence varied significantly between health boards' areas (p <0.001); the highest incidence being reported in Dumfries (14.2/1,000 population), which was 11 times greater than that in Ayrshire (1.3/1,000 population). There was no significant association between risk of dental injury and increasing deprivation (p = 0.956); in DEPCAT 1 (most affluent) the incidence was 6.4/1,000 population, while in DEPCAT 7 (most deprived) the incidence was 5.7/1,000 population. CONCLUSION: The incidence of dental injury is varied among health boards, though it had significantly decreased since 1993. Gender and deprivation level had no effect on incidence of dental injury.

Epidemiology of traumatic dental injuries.

The oral region comprises 1% of the total body area, yet it accounts for 5% of all bodily injuries. In preschool children, oral injuries make up as much as 17% of all bodily injuries. The incidence of traumatic dental injuries is 1%-3%, and the prevalence is steady at 20%-30%. The annual cost of treatment is US $2-$5 million per 1 million inhabitants. Etiologic factors vary between countries and with age groups. Important public health implications such as how to best organize emergency dental care and how to prevent dental injuries, decrease cost, and increase lay knowledge are important factors needed to change epidemiologic data toward more favorable figures in the future.

Frequency and characteristics of occupational dental trauma.

BACKGROUND: Dental trauma at the workplace may have important clinical and occupational consequences, but little is known about its profile. AIMS: To describe the frequency and characteristics of work-related dental injuries. METHODS: For all patients with occupational dental trauma seen at the FREMAP Hospital of Barcelona (Spain) between January 2000 and December 2006, we recorded their characteristics, type of work and nature of the trauma, including cause of the accident, extent of trauma, reason for referral to a dentist, and days of sick leave. RESULTS: The frequency of dental trauma was 1.71 per 1000 occupational accidents attended and was related to the worker's occupation. In security services, it was 7.37 per 1000 and 2.01 in transport services. The frequency was similar in both genders. The most common causal mechanisms were direct impact (38%), traffic accidents (29%) and falls at the same level (16%). Causal mechanisms differed according to gender and type of job. Most injuries consisted of dental fracture (54%), and 67% of the patients required referral to a dental surgery. Injuries were limited to the mouth in 52% of cases, 8% of which required sick leave, with a mean duration of 23.0±21.8 days. CONCLUSIONS: The frequency of dental trauma in this working population was low and was related to the worker's occupation. Causal mechanisms differed according to gender and type of job. Most dental injuries were severe and required referral to a dental surgery. Frequency of sick leave was low.

Expert witnesses in dentistry: a comparison between Italy and Croatia.

A dentist is frequently required to translate dental trauma into monetary value, for example after car accidents and/or work-related injuries. When called to act in this capacity a dentist should combine his/her biological and technical knowledge with a quality medico-legal knowledge. Calculation of economic (pecuniary) damages and non-economic (non-pecuniary) damages requires specific training in medico-legal matters and awareness of the inherent pitfalls. Expert Witnesses registered in Court are usually asked to perform this duty. Nevertheless, European countries have differences regarding dental damage evaluations as well as significant differences in the conditions required for registration as an Expert Witness in Court. A dental Expert Witness has precise responsibilities and is subject to civil or criminal proceedings (depending on the judicial system) if found wanting. In forensic/legal dentistry a medico-legal doctor should not work in isolation from a dentist in dental cases nor is it wise for a dentist to work in the courts without having had specific training regarding judicial disciplines relating to dental damages. In this preliminary work the authors investigate the principal differences in the judicial systems regarding the appointment of Expert Witnesses in both Italian and Croatian courts. The next step will expand this investigation through to European countries in order to marshal knowledge towards harmonization, best practice and a common ground for dental evaluation and claim compensations (in accordance with the Council of Europe Resolution 75 ­ 7 Compensation for physical injury or death).

The dentist's responsibilities with respect to a nofault motor accident compensation scheme.

The State of Victoria, Australia operates a no-fault accident compensation scheme for the treatment and rehabilitation of those injured on the roads. The administration of the scheme by the Transport Accident Commission includes an in-house clinical panel of clinicians in many disciplines including dentistry who liaise with treating practitioners with the aim of optimizing the outcome for the injured claimants.

[Financial and medicolegal impact of dental trauma]. / Impact financier et médicolégal des traumatismes dentaires.

INTRODUCTION: Dental injuries are among the most common complications of general anesthesia. Yet few studies have assessed the costs and factors that involve the responsibility of the anesthetist. STUDY DESIGN: A retrospective study was conducted at the university hospital of Reims on 46 cases of dental injuries directly related to anaesthesia. RESULTS: Ten patients made a claim for compensation. Two of them have received compensation following a medical expertise, which revealed for the first patient a possible alternative to general anaesthesia, and the second, hardware failure of intubation. The Administrative Court was entered once in 9 years. The global insurance-cost amounts to 4476 euros for all patients. The review of all cases of anaesthesia shows clearly that the dental claims are associated with a significant under clinical evaluation of dental status and criteria for difficult intubation during the anaesthesia. The information to the patient on this risk is not obvious from reading the anaesthesia records. No mouth guard was used. CONCLUSION: This work proves that the statements of caution are the most common and a minority of dental trauma lead to a claim. Claims are due to the high cost of dental care repair. The proportion of patients receiving benefits is extremely low. Medical expertise is an essential part of the evaluation of medical responsibilities. No compensation was paid without expertise. The lack of physical examination and information are contrary to our professional obligations and may involve our responsibility. The lack of patient information is not generated for compensation to the extent that the consequences of failure are easily dental weighed against the benefits of the entire medical-surgical procedure that the patient has agreed.

The impact of dental caries and trauma in children on family quality of life.

OBJECTIVES: To assess the impact of children's dental caries (DC) and traumatic dental injuries (TDI) on parents' quality of life (QoL), adjusted by family income. METHODS: Parents of 219 children aged 5 and 6 years answered the Family Impact Scale (FIS) on their perception of QoL and data about income. Three calibrated dentists examined the severity of DC according to decayed, missing and filled permanent teeth index, and children were categorized into: 0 = caries free; 1-5 = low severity; and ≥ 6 = high severity. TDI were classified into uncomplicated and complicated injuries. QoL was measured through FIS items and total score, and Poisson regression was used to associate the variables with the outcome. RESULTS: Severity of DC showed a negative impact on the total score and subscales on parental/family activities, parental emotions and financial burden (P < 0.001). TDI showed a negative impact on total score and in some FIS items. The multivariate-adjusted model showed that only the increase in the severity of children's DC (RR = 3.19; 95% CI = 2.36, 4.31; P < 0.001) was associated with a greater negative impact on parents' QoL, while high family income was a protective factor (RR = 0.68; 95% CI = 0.48, 0.95; P < 0.001). CONCLUSIONS: The severity of children's DC has a negative impact on parents' QoL, whereas TDI do not. A lower family income might have a negative impact on parents' QoL.

Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment.

[Dental trauma and anaesthesiology: epidemiology and insurance-related impact over 4 years in Rouen teaching hospital]. / Lésions dentaires et anesthésie : épidémiologie et impact assurantiel sur quatre années au CHU de Rouen.

OBJECTIVES: Dental injuries are the first cause of sinistrality in anaesthesiology. However, few insurance-related data are available concerning the publicly-owned establishments, in particular on the cost of the complaints deposited. We studied the epidemiology of dental trauma in a teaching hospital and brought it closer to the induced insurance-related costs. PATIENTS AND METHODS: We conducted a retrospective study, examining the files of declaration of dental trauma, from January 2005 to December 2008. The litigations for dental injuries treated by Quality and Services Department were also analysed. RESULTS: Seventy-two cases of dental lesions were declared, i.e. 1/1528 general anaesthesias. Concerning the risk factors of lesion, 47 patients (65%) presented bad dental conditions identified during the pre-anaesthetic consultation; 27 patients (37%) had criteria for difficult intubation listed on the sheet of anaesthesia. The association of the 2 factors was found among 20 patients. The indication of information to the patient on the dental risk was registered on the sheet of anaesthesia in 17% of cases. The Quality and Services Department recorded 23 complaints for dental trauma over the period. In 4 cases the complaint was followed by a compensation for an average amount equal to 608 (256-1002) Euros, i.e., a total cost of 2434 Euros. CONCLUSIONS: The two main risk factors of dental lesion are well identified with the consultation of anaesthesia and are noted on the file. However, information to the patient on this risk is seldom notified. The incidence of dental lesions is important, but few complaints open right to financial repair for a very low insurance-related total amount.

Litigation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995-2007.

Claims notified to the NHS Litigation Authority in England between 1995 and 2007 and filed under anaesthesia were analysed to explore patterns of injury and cost related to airway or respiratory events. Of 841 interpretable claims the final dataset contained 96 claims of dental damage, 67 airway-related claims and 24 respiratory claims. Claims of dental damage contributed a numerically important (11%), but financially modest (0.5%) proportion of claims. These claims predominantly described injury during tracheal intubation or extubation; a minority associated with electroconvulsive therapy led to substantial cost per claim. The total cost of (non-dental) airway claims was 4.9 million pounds (84% closed, median cost 30,000 pounds) and that of respiratory claims was 3.3 million pounds (81% closed, median 27,000 pounds). Airway and respiratory claims account for 12% of anaesthesia-related claims, 53% of deaths, 27% of cost and ten of the 50 most expensive claims in the dataset. Airway claims most frequently described events at induction of anaesthesia, involved airway management with a tracheal tube and typically led to hypoxia and patient death or brain injury. Airway trauma accounted for one third of airway claims and these included deaths from mediastinal injury at intubation. Pulmonary aspiration and tube misplacement, including oesophageal intubation, led to several claims. Among respiratory claims, ventilation problems, combined with hypoxia, were an important source of claims. Although limited clinical details hamper analysis, the data suggest that most airway and respiratory-related claims arise from sentinel events. The absence of clinical detail and denominators limit opportunities to learn from such events; much more could be learnt from a closed claim or sentinel event analysis scheme.

Hidden consequences of dental trauma: the social and psychological effects.

It has been recognized that childhood and adolescence are high-risk periods for dental injuries, with approximately 80% occurring in individuals younger than 20-years-old. Childhood and adolescence are sensitive growth periods that may pose serious challenges to managing dental trauma. Compliance and cooperation often are issues, and family involvement--starting from the moment of injury--is critical. Moreover, long-term follow up and monitoring are essential, especially in the growing patient with a developing dentition. The potential for psychological and social impacts of dental trauma has become a common finding with consequences that may impair the social functioning, emotional balance, and wellbeing of the child. The purpose of the present paper was to outline and review the multilevel effects of pediatric dental trauma regarding emergency care and subsequent treatment, time, and costs incurred for the family and health care system, along with immediate and long-term emotional and social impacts.