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Definitions of Medical Injuries
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To the Editor: Drs Zhan and Miller1 should have made a distinction between events that should never occur (eg, transfusion reaction from patient misidentification, wrong site surgery, retained surgical instrument) and those that may be treatment related. The former are directly linked to malfunction of hospital systems; although the latter are important, they are more difficult to sort out in a retrospective review of complicated data. The "should never occur" events appeared to be rare, as they should have been. "Injuries" occur in even the best of hospitals with the best of systems. In these cases, the events are more likely to be a reflection of the underlying disease processes. It would be entirely misleading to code postoperative sepsis following rupture of necrotic bowel as a "medical injury."
James B. Carr, MD
Palmetto Health Orthopedics
Columbia, SC
1. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290:1868-1874.
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Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2004;291:304.
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