| Litigation in nontraumatic aortic diseases--a tempest in the malpractice maelstrom. | |
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MedLine Citation:
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PMID: 17873491 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Physicians are vulnerable to highly litigated thoracic aortic diseases. On the basis of a review of litigated cases, we aim to determine legally protective strategies for physicians and methods to improve treatment. METHODS: Thirty-three nontraumatic, thoracic aorta-related legal cases were analyzed. RESULTS: Twenty-three patients (69.7%) had dissections (21 ascending, 2 descending), 8 (24.2%) had aneurysms and 2 had miscellaneous other phenomena (1 coarctation and 1 iatrogenic descending aortic rupture). The adverse event was death in 30 (90.9%) patients and paraplegia or stroke in 3 (9.1%). Allegations included: failure/delay in diagnosis (19), delay in surgery (4), error in surgical technique (5), failure to prevent paraplegia (2) and miscellaneous (3). Medical treatment was retrospectively judged suboptimal in 22 cases (66.6%) for reasons consonant with allegations. CONCLUSIONS: Aortic disease can be diagnostically elusive, as 'the great masquerader'. Emergency physicians must maintain a high index of suspicion for aneurysm and dissection. The D-dimer test can effectively rule out aortic dissection. 'Triple rule-out' CT scans should be performed liberally. CT scan readers must remember to evaluate the aorta. Operating room administrators must be aware that postponing a scheduled thoracic aortic case may result in interim rupture and consequent litigation. With virulent thoracic aortic diseases, adverse outcome itself does not imply substandard care. |
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Authors:
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John A Elefteriades; Peter W Barrett; Gary S Kopf |
Publication Detail:
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Type: Journal Article Date: 2007-09-17 |
Journal Detail:
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Title: Cardiology Volume: 109 ISSN: 1421-9751 ISO Abbreviation: Cardiology Publication Date: 2008 |
Date Detail:
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Created Date: 2008-03-03 Completed Date: 2008-03-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1266406 Medline TA: Cardiology Country: Switzerland |
Other Details:
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Languages: eng Pagination: 263-72 Citation Subset: IM |
Copyright Information:
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2007 S. Karger AG, Basel |
Affiliation:
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Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn. 06510, USA. john.elefteriades@yale.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aortic Diseases / diagnosis*, surgery* Humans Malpractice / legislation & jurisprudence* Middle Aged Thoracic Surgery* Treatment Outcome United States |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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