38 yr old obese white female with no prior medical issues and on no medications, complained of leg pain of 4-5 day duration without improvement. Pt went to her PCP on Tuesday and saw the PA who dismissed notion that it was blood clot since there was no redness. They did blood work, but no doppler imaging or thrombolytics, and she was sent her home. The following morning clot broke loose as she had trouble breathing, was transported to the ER and pronounced DOA. Autopsy findings were; pulmonary thromboembolism, DVT of left leg, obesity and periods of recent immobility .
Was the PCP office negligent in not performing further testing, and if so would the outcome have been different?
MEDQUEST EXPERT RESPONSES:
Obesity and recent immobility during travel would put this patient at risk for DVT. Should have gotten a doppler. Treatment likely would have saved her. Dr VW – Family Practicioner
Did they examine the calf, check for a positive Homan’s sign, do bloodwork and was there any edema? If they suspected a dvt and acted she’d have lived. Dr HG – Family Practicioner
Redness if present suggests the less worrisome form called superficial phebitis. Deep vein phebitis presents with leg pain and swelling. Typically if no other diagnosis such as a pulled muscle can be proven DVT needs to be explored. Dr MC –Family Practicioner
Erythema is only one of the cardinal signs of deep venous thrombosis. The others are pain, assymmetry in the size of the calves and pitting edema. A personal history of hypercoagulability or a prior DVT, or a family history of clotting may also be very helpful. This was definitely a preventable death had the attending done the appropratie Doppler studies.
I represented a client in a similar case. The delay in diagnosis of a DVT led to a pulmonary embolism and death.
Had a Doppler been done, DVT would have been treated and the patient’s death would have been prevented.
Case settled prior to trial.