AMERICAN SOCIETY OF ANESTHESIOLOGISTS CLOSED CLAIMS
DATA AND PRACTICE ADVISORIES
Two analyses of nerve injury cases from the ASA Closed Claims
Database have been published, the most recent in 1999.[1]
This database is derived from case summaries from the closed claims files of professional
liability insurance companies. Of all anesthesia claims, death (32%), nerve damage
(16%), and brain damage (12%) were the types most frequently settled. Six hundred
seventy (16%) of 4183 total claims closed between 1970 and 1995 involved nerve injury
claims. Table 28-1
summarizes
the distribution of the most frequent injuries by gender. Although female claimants
predominated in non-nerve damage claims, the distribution between genders was equal
for nerve damage cases. Most nerve injuries occurred in adults; less than 1% of
closed claims for nerve injury cases involved children.
Ulnar neuropathies predominated (28%) in the 670 nerve injury
cases, followed by brachial plexus, lumbosacral nerve root, and spinal cord injuries
in the ASA Closed Claims Database ( Table
28-2
). Ulnar neuropathies were far more common in male than female patients.
Some of the nerve injury cases are not related to positioning.
An increasing incidence of spinal cord injuries in the database was observed for
claims for injury occurring in the 1990s.[1]
This
trend may be related to increasing injuries from neuraxial blocks in anticoagulated
patients, the introduction of low-molecular-weight heparin, and more blocks performed
for chronic pain management. The ASA Closed Claims Database also includes reports
on two patients who sustained cervical cord injuries when they fell off the operating
room table!
In 1999, the ASA Task Force on Prevention of Perioperative Peripheral
Neuropathies approved a practice advisory for the prevention of perioperative peripheral
neuropathies.[2]
The Task Force's report is called
a practice advisory because this type of document
is not supported by scientific literature to the same degree as standards or guidelines.
The Task Force reviewed 509 positioning studies and found that only 6 demonstrated
scientifically proven relationships between interventions and outcomes. Because
there was so little objective information, the Task Force did not rely completely
on the literature but built a consensus after obtaining consultant opinion from a
body of anesthesiologists and other specialists with experience in patient positioning.
The summary of the Task Force's advisory is reprinted in Table
28-3
.
TABLE 28-1 -- Distribution of the most common ASA Closed Claims Database Injuries by Gender
and Age
|
Claim |
Male (%) |
Female (%) |
Median Age (yr) |
Age Range (yr) |
Persons <16 Years Old (%) |
|
Non-nerve damage (n = 3513) |
38 |
61 |
39 |
0–94 |
11 |
|
All nerve damage (n = 670) |
50
*
|
49
*
|
44
*
|
1–86 |
1
*
|
|
Ulnar (n = 190) |
75
*
|
23
*
|
50
*
|
20–82 |
0
*
|
|
Brachial plexus (n = 137) |
40 |
58 |
41
†
|
1–80 |
1
*
|
|
Lumbosacral root (n = 105) |
29
†
|
71
†
|
37 |
20–83 |
0
*
|
|
Spinal cord (n = 84) |
52
†
|
48
†
|
54
*
|
2–86 |
5
†
|
|
All other nerves (n = 154) |
42 |
58 |
40 |
5–81 |
2
*
|
|
From Cheney FW, Domino KB, Caplan RA, et al: Nerve
injury associated with anesthesia. Anesthesiology 90:1064, 1999. |
*P
≤ 0.01 versus non-nerve damage claims.
†P
≤ 0.05 versus non-nerve damage claims.
