Pediatric Radiology

, Volume 38, Supplement 4, pp 645–650 | Cite as

Standards for clinical evaluation and documentation by the emergency medicine provider

  • Steven M. SelbstEmail author


Pediatric emergency medicine is full of challenges. When a pediatric patient has a poor outcome after treatment in an emergency department (ED), a malpractice lawsuit is likely to result. Pediatric emergency medicine (PEM) physicians might sometimes alter their medical care and practice “defensive medicine” in hopes of avoiding a malpractice lawsuit. Radiographs and other diagnostic studies might be ordered without true indications to “completely rule out” a diagnosis. This can result in excess radiation for a child. On the other hand, failure to order the appropriate study or misinterpretation of a radiographic study by a radiologist or an emergency physician can result in a malpractice lawsuit. PEM physicians must work cooperatively with radiologists to improve the care for children in the ED. Together these specialists can decide on appropriate studies for children in the ED, keep radiation exposure to a minimum and ensure proper management based on these studies.


Malpractice Standard of care Pediatric emergency medicine Radiology Consultation 


  1. 1.
    Laska L (ed) (1995) Medical Malpractice Verdicts Settlements and Experts. 11:4Google Scholar
  2. 2.
    McAbee G (2006) Pediatricians and the law—pediatrics among specialties with highest payments for closed malpractice claims in 1985–2005. Physician Insurers Association of America, AAP News, p 18Google Scholar
  3. 3.
    Trautlein JJ, Lambert RL, Miller J (1984) Malpractice in the ED—review of 200 cases. Ann Emerg Med 13:709PubMedCrossRefGoogle Scholar
  4. 4.
    Rogers JT (1985) Risk management in emergency medicine. American College of Emergency Physicians, DallasGoogle Scholar
  5. 5.
    Anonymous (2002) AAP Divisions of Health Care Finance and Practice and Health Policy Research. Medical liability trends in pediatrics change little. AAP News, p 159Google Scholar
  6. 6.
    Selbst SM, Friedman MJ, Singh SB (2005) Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care 21:165–169PubMedCrossRefGoogle Scholar
  7. 7.
    Sites RL (1990) Emergency department closed malpractice claims: Ohio. Perspectives in Health Care Risk Management, Spring, pp 17–21Google Scholar
  8. 8.
    Selbst SM, Korin JB (1999) Preventing malpractice lawsuits in pediatric emergency medicine. American College of Emergency Physicians, Dallas, TX, pp 1–196Google Scholar
  9. 9.
    Studdert DM, Mello MM, Sage WM et al (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 293:2609–2617PubMedCrossRefGoogle Scholar
  10. 10.
    Katz DA, Williams GC, Brown RL et al (2005) Emergency physicians’ fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med 46:525–533PubMedCrossRefGoogle Scholar
  11. 11.
    Rodriquez RM, Anglin D, Hankin A et al (2007) A longitudinal study of emergency medicine residents’ malpractice fear and defensive medicine. Acad Emerg Med 14:569–573Google Scholar
  12. 12.
    Andrew LB (2006) Expert witness testimony: the ethics of being a medical expert witness. Emerg Med Clin NA 24:715–731CrossRefGoogle Scholar
  13. 13.
    Selbst SM, Korin JB (2000) Malpractice and emergency care: doing right by the patient and yourself. Cont Peds 17:88–106Google Scholar
  14. 14.
    George JE, Espinosa JA, Quattrone MS (1992) Legal issues in emergency radiology. Emerg Med Clin NA 10:179–203Google Scholar
  15. 15.
    Singh H, Thomas EJ, Petersen LA et al (2007) Medical errors involving trainees—a study of closed malpractice claims from 5 insurers. Arch Intern Med 167:2030–2036PubMedCrossRefGoogle Scholar
  16. 16.
    Klein EJ, Koenig M, Diekema DS et al (1999) Discordant radiograph interpretation between emergency physicians and radiologists in a pediatric emergency department. Ped Emerg Care 15:245–248CrossRefGoogle Scholar
  17. 17.
    Fleisher GR, Ludwig S, McSorley M (1983) Interpretation of pediatric X-ray films by emergency department pediatricians. Ann Emerg Med 12:153–158PubMedCrossRefGoogle Scholar
  18. 18.
    Selbst SM (2006) Pediatric emergency medicine legal briefs. Pediatr Emerg Care 22:201PubMedCrossRefGoogle Scholar
  19. 19.
    Selbst SM (1999) Pediatric emergency medicine legal briefs. Pediatr Emerg Care 15:231PubMedCrossRefGoogle Scholar
  20. 20.
    Beckman HB, Markakis KM, Suchman AL et al (1995) The doctor–patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med 155:543Google Scholar
  21. 21.
    Hickson GB, Clayton EW, Githens PB et al (1992) Factors that prompted families to file malpractice claims following perinatal injuries. JAMA 267:1359–1363PubMedCrossRefGoogle Scholar
  22. 22.
    Hickson GB, Federspiel CF, Pichert JW et al (2002) Patient complaints and malpractice risk. JAMA 287:2951–2957PubMedCrossRefGoogle Scholar
  23. 23.
    Kachalia A, Gandhi TK, Puopolo AL et al (2007) Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med 49:196–205PubMedCrossRefGoogle Scholar
  24. 24.
    Holliman CJ (1993) The art of dealing with consultants. J Emerg Med 11:633–640PubMedCrossRefGoogle Scholar
  25. 25.
    Taylor GA (2004) Suspected appendicitis in children: in search of the single best diagnostic test. Radiology 231:293–295PubMedCrossRefGoogle Scholar
  26. 26.
    Coley B (2007) Appendicitis in children: one radiologist’s perspective. Pediatr Radiol 37:1–3PubMedCrossRefGoogle Scholar
  27. 27.
    Selbst SM (2007) Pediatric emergency medicine legal briefs. Pediatr Emerg Care 23:594CrossRefGoogle Scholar
  28. 28.
    Guerther AT, Cortazzo JM, Rice MM (1994) Referral and consultation in emergency medicine practice. Acad Emerg Med 1:565–571Google Scholar
  29. 29.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Jefferson Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Division of Emergency MedicineA.I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations