Literature Review: A Roundup of Important Recent Studies

Bottom line: Primary lymphoma of the parotid gland, although uncommon, is important to consider during parotid lesion evaluation and treatment.

Citation: Feinstein AJ, Ciarleglio MM, Cong X, Otremba MD, Judson BL. Parotid gland lymphoma: prognostic analysis of 2,140 patients. Laryngoscope. 2013:123:1199-1203.

—Reviewed by Amy Eckner

Better Dialogues with Patients May Minimize Liability in Cranial Nerve Injury Malpractice Trials

Can knowledge of factors that affect outcomes in cranial nerve (CN) malpractice trials help physicians develop strategies to reduce professional liability and improve medical outcomes?

Background: Direct costs for health care professionals associated with malpractice litigation are estimated at between $6.5 and $10 billion per year. To date, there have been no analyses of litigation regarding CN I, II, III, IV, V, VI, VIII, IX, XII or any associated branches. Trials were examined for characteristics including nerve(s) injured, alleged causes, location, patient demographics, procedure and defendant specialty and outcome, among others. Out-of-court settlements were not considered, but the mean settlement amount was lower than the mean verdict award.

Study design: Retrospective analysis of jury verdict reports related to medical malpractice and CN injury.

Setting: The Westlaw database (Thomson Reuters, New York, N.Y.) was used to examine 209 trials; American Association of Medical Colleges figures were used to determine the number of practicing surgeons per state.

Synopsis: Average plaintiff age was 47.2 years, with 55 percent female; trial years ranged from 1984 to 2011. The most commonly litigated CN cases involved the facial (24.4 percent) and optic (19.6 percent) nerves; damages for optic nerve cases were higher than for all other CNs. The most frequently litigated nerves were CN VII, II, X and XI, respectively; there were no trials for CN IV, VI and IX. Recurrent laryngeal nerve damage was found in 96.9 percent of CN X cases. Damages were awarded in 33 percent of trials. The most commonly named defendants were otolaryngologists (26.3 percent) and general surgeons (17.7 percent). The highest CN malpractice case frequencies were found in Missouri, California, Ohio, Rhode Island and Alaska. The highest mean jury awards were for optic nerve injury ($3.1 million). Factors most frequently present were alleged informed consent defects (25.4 percent), complications requiring surgery (25.8 percent) and failure to recognize complications in a timely way (23.9 percent). For informed consent defects, specific complications not being mentioned as possibilities and “non-adverse” outcomes that make patients unhappy (e.g., cosmetic deformities) can result in litigation. Study limitations included variability of detail level and type among cases, and some voluntarily submitted Westlaw records rather than federal and state court records.