A review of reported litigation against English health trusts for the treatment of children in orthopaedics: present trends and suggestions to reduce mistakes

Purpose: Large scale databases that offer a reflection of clinical negligence are rare. By assessing commonly occuring cases of negligence, we hope to highlight areas where pediatric orthopedic care might be improved. One such database is the National Health Service Litigation Authority, which deals with claims brought against all health trusts in England. By collating their data we aimed to highlight areas of commonly occurring clinical negligence and then suggest ways to avoid similar happening again.

Method: We reviewed all cases pertaining to pediatric orthopedic claims between 1995 to 2006 as provided by the NHSLA.

Results: Of those considered in our study (341), by far the most common cause of litigation is missed or incorrectly diagnosed injuries/ conditions-accounting for 57% of all cases. 44% of those are upper limb injuries, mainly fractures around the elbow. Misdiagnosed disorders of the hip such as hip dysplasia and SCFE also represent a frequent reason for litigation (11%). Other common causes are poor plaster application and removal (7.3%) and non-surgical site specific errors such as chemical burns from skin prep.

Conclusion: Although specific to the English system, these findings are likely to mirror that found in other countries. Highlighting these commonly occurring errors, better education of doctors in targeted areas and due care in simple procedures may have significant improvement of child orthopedic care.