title: Delayed diagnosis in primary care-The main cause of sarcoma litigation in the United Kingdom.
abstract: BACKGROUND
  Poor awareness and knowledge of lumps and bumps can impact on patient outcomes and survival. Late referrals or false reassurance may lead to litigation proceedings. The aim of this study was to identify the litigation cost in sarcoma care and identify areas for improvement.
  
  
  METHODS
  Orthopaedic litigation between 1995-2010 in England and Wales was obtained from the National Health Service Litigation Authority. Litigation specifically relating to sarcoma in the extremities was identified. Causation, compensation fee, cost of legal defense, and compensation were analyzed.
  
  
  RESULTS
  There were 52 litigation claims. Negligence was proven in 71% (n = 37) of cases. The total cost was £4.4 million (mean of £84,000/case). The mean compensation award was £92,000 (range £650-£978,000) and the mean defense cost was £22,000 (range £0-£102,000). Delayed diagnosis accounted for 89% of cases (n = 48). Negligence following diagnosis was infrequent; inappropriate treatment (n = 2), failure to recognize complications of surgery (n = 2), intra-operative problems (n = 1), failure to refer to a specialist unit after a "whoops procedure" (n = 1).
  
  
  CONCLUSIONS
  Once the patient is within the specialist sarcoma unit, there is a very low rate of litigation. Efforts to reduce litigation in sarcoma treatment should focus on early diagnosis and raising awareness of sarcomas. J. Surg. Oncol. 2016;113:361-363. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Liverpool Sarcoma Unit, Royal Liverpool and Broadgreen University Hospitals, United Kingdom.
authors.forename: William D
authors.initials: WD
authors.lastname: Harrison
authors.affiliation: Liverpool Sarcoma Unit, Royal Liverpool and Broadgreen University Hospitals, United Kingdom.
authors.forename: Nastaran
authors.initials: N
authors.lastname: Sargazi
authors.affiliation: Liverpool Sarcoma Unit, Royal Liverpool and Broadgreen University Hospitals, United Kingdom.
authors.forename: Qi
authors.initials: Q
authors.lastname: Yin
authors.affiliation: Liverpool Sarcoma Unit, Royal Liverpool and Broadgreen University Hospitals, United Kingdom.
authors.forename: Coonoor R
authors.initials: CR
authors.lastname: Chandrasekar
mesh_terms: D057210:Delayed Diagnosis / Q000331:legislation & jurisprudence*; D004739:England; D006801:Humans; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence; D008495:Medical Oncology / Q000191:economics / Q000331:legislation & jurisprudence; D009985:Orthopedics / Q000191:economics / Q000331:legislation & jurisprudence; D011320:Primary Health Care / Q000191:economics / Q000331:legislation & jurisprudence* / Q000379:methods; D012509:Sarcoma / Q000175:diagnosis* / Q000191:economics; D013222:State Medicine / Q000191:economics / Q000331:legislation & jurisprudence; D014852:Wales
keywords: awareness; litigation; medicolegal; negligence; sarcoma