Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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."
Carr JB. Definitions of Medical Injuries. JAMA. 2004;291(3):303. doi:10.1001/jama.291.3.304-b