Common Reasons for Malpractice Lawsuits Involving Pulmonary Embolism and Deep Vein Thrombosis

Wilson, Eelin; Phair, John P.; Carnevale, Matthew; Koleilat, Issam

doi:10.1016/j.jss.2019.07.079

Cited by 14 publications

(4 citation statements)

References 16 publications

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“…15 For vascular surgeons, aortic interventions account for approximately 11% of procedures leading to litigations. 16 Previous reviews have focused on litigation in relation to various topics in vascular surgery [17][18][19][20] and other areas of medicine, 12,21 but malpractice claims in aortic aneurysms and dissections have not been extensively analyzed thus far.…”

Section: Introductionmentioning

confidence: 99%

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

Choinski

Sanon

Tadros

et al. 2021

Vasc Endovascular Surg

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Objective: Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes. Methods: Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included “aortic aneurysm” and “aortic dissection.” Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases. Results: A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included “failure to diagnose and treat” (61%), “delayed diagnosis and treatment” (21%), “post-operative complications after open repair” (10%) and “negligent post-operative care” (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462). Conclusion: For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.

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Section: Introductionmentioning

confidence: 99%

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

Choinski

Sanon

Tadros

et al. 2021

Vasc Endovascular Surg

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“…Despite the awareness that the clinical presentation of pulmonary embolism can be elusive, recent reports point out that diagnostic delays 14 and underestimations are very common, and the reasons can be multiple. 15 However, the differential diagnosis of pulmonary embolism has recently become complicated considering the typical clinical presentation of COVID-19 pneumonia. [16][17][18] Furthermore, it is well known that the management of the psychiatric patient with psychomotor agitation in the emergency room is extremely complex.…”

Section: Discussionmentioning

confidence: 99%

Massive pulmonary embolism masked as an episode of acute agitation in a psychiatric patient: a case report

2020

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Management of the psychiatric diseases’ reacutization is a frequent occurrence in emergency medicine. During this COVID-19 pandemic, a further increase in access to the emergency room was reported, and the reasons are numerous. Although the essential prerogative of the emergency department is to provide immediate clinical assistance by rapidly setting an effective diagnostic and therapeutic path, there are multiple obstacles to providing adequate care for Emergency Department patients with mental illness. In this report, we describe the case of a 65-year-old female patient with severe schizophrenia who was evaluated in the emergency room for acute agitation masking a subtle persistent dyspnea. The possibility of an underlying medical cause should not be underestimated or completely forgotten due to the difficult approach to the psychiatric patient.

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“…Several studies describing autopsies noted that 55%-70% of PE diagnoses were missed prior to death [4][5][6][7][8]. An analysis of claims in malpractice litigation found that PE is a common basis for death lawsuits, with 62% classified as an allegation of "failure to diagnose and treat" [9].…”

Section: Introductionmentioning

confidence: 99%

Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients

Pinevich¹,

Barwise²,

Austin³

et al. 2023

Biomol Biomed

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There is a lack of diagnostic performance measures associated with pulmonary embolism (PE). We aimed to explore the concept of the time to diagnostic certainty, which we defined as the time interval that elapses between first presentation of a patient to a confirmed PE diagnosis with computed tomography pulmonary angiogram (CT PA). This approach could be used to highlight variability in health system diagnostic performance, and to select patient outliers for structured chart review in order to identify underlying contributors to diagnostic error or delay. We performed a retrospective observational study at academic medical centers and associated community-based hospitals in one health system, examining randomly selected adult patients admitted to study sites with a diagnosis of acute saddle PE. One hundred patients were randomly selected from 340 patients discharged with saddle PE. Twenty-four patients were excluded. Among the 76 included patients, time to diagnostic certainty ranged from 1.5 to 310 hours. We found that 73/76 patients were considered to have PE present on admission (CT PA ≤ 48 hours). The proportion of patients with PE present on admission with time to diagnostic certainty of > 6 hours was 26% (19/73). The median (IQR) time to treatment (thrombolytics/anticoagulants) was 3.5 (2.5-5.1) hours among the 73 patients. The proportion of patients with PE present on admission with treatment delays of > 6 hours was 16% (12/73). Three patients acquired PE during hospitalization (CT PA > 48 hours). In this study, we developed and successfully tested the concept of time to diagnostic certainty for saddle PE.

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Common Reasons for Malpractice Lawsuits Involving Pulmonary Embolism and Deep Vein Thrombosis

Cited by 14 publications

References 16 publications

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

Massive pulmonary embolism masked as an episode of acute agitation in a psychiatric patient: a case report

Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients

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