Document Detail


Litigation in nontraumatic aortic diseases--a tempest in the malpractice maelstrom.
MedLine Citation:
PMID:  17873491     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
John A Elefteriades; Peter W Barrett; Gary S Kopf
Publication Detail:
Type:  Journal Article     Date:  2007-09-17
Journal Detail:
Title:  Cardiology     Volume:  109     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2008  
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-03-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  263-72     Citation Subset:  IM    
Copyright Information:
2007 S. Karger AG, Basel
Affiliation:
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn. 06510, USA. john.elefteriades@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Diseases / diagnosis*,  surgery*
Humans
Malpractice / legislation & jurisprudence*
Middle Aged
Thoracic Surgery*
Treatment Outcome
United States

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