Document Detail


Lethal pulmonary thromboembolism: An autopsy-based study on a rare but legally relevant event.
MedLine Citation:
PMID:  24003084     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Context: Pulmonary thromboembolism (PTE) is the severe end stage of many different diseases producing prolonged patient immobilization or a hypercoagulative state. Lethal PTE is also one of the most frequent topics for suspected medical malpractice, especially dealing with patients originally affected by non-critical illnesses and suddenly killed by a non-prevented embolic event. The crucial forensic question about a lethal PTE is the following one: was this lethal PTE an unpreventable complication or was it a consequence of a real medical malpractice?Materials and methods: The authors analyzed the 1999-2009 autoptic archive of the Institute of Forensic Medicine of the Milan University and selected all the cases having a PTE as the cause of death. For every selected case, the authors also collected all the available demographic and clinical data. Statistical analysis was performed using SPSS V.16.00.Results: In the period 1999-2009, 129 (1.25%) cases out of a whole amount of 10,288 autopsies were diagnosed as having suffered lethal PTE. The male to female ratio was 1:2 (34.1% versus 65.9%). The mean age at death was 67 ± 18 years. In 41% of cases the exitus occurred away from the hospital and in the absence of any medical support, in 36.5% during the territorial paramedical support or during the very first evaluation in the emergency department and in the remaining 22.5% during a period of hospitalization. In 33.4% of the selected cases, a typical preliminary event was positively identified: a pure major trauma (18.6%), a trauma followed by a major surgery (7%), a major non post-traumatic surgery (7%) and a non-surgical delivery. Symptoms suggesting PTE were detected in 46 cases (35.7%). Nine cases underwent a judicial autopsy in the same original hypothesis of a medical malpractice for wrong prophylaxis in acutely bed-restricted patients.Conclusions: Post-surgical PTE cannot be automatically labeled as a consequence of medical malpractice. The combination of right prophylaxis, careful diagnostic monitoring of the high-risk patient and right therapy surely reduces the occurrence of lethal PTE, but it does not completely erase such an insidious pathology. In the hypothesis of a causative medical malpractice, only the careful analysis by an experienced forensic pathologist can make a reliable distinction between an unpreventable complication and a real medical malpractice.
Authors:
Francesca Mobilia; Michelangelo B Casali; Maurizio Gallieni; Umberto R Genovese
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-9-3
Journal Detail:
Title:  Medicine, science, and the law     Volume:  -     ISSN:  0025-8024     ISO Abbreviation:  Med Sci Law     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-9-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400721     Medline TA:  Med Sci Law     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Laboratory of Medical Malpractice and Health Liability, Institute of Forensic Medicine, Milan University, Italy.
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