Another Example of Delayed Diagnosis of Hospital Infections

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Another Example of Delayed Diagnosis of Hospital Infections

The New York Times reported yesterday about a 12 year-old who died from infection after abnormal test results were ignored in a New York City hospital.  The boy had a known and treatable infection that progressed over a few days to sepsis and shock.  Had the boy’s test results been heeded, antibiotics would have undoubtedly saved his life.  This type of medical negligence is all too common.

Often, superficial infections are successfully defended by the body’s own immune system.  In typical fashion, the body will send white blood cells to combat infection.  However, on occasion, an infection is significant enough that the body generates a systemic response. This systemic response, called Systemic Inflammatory Response Syndrome (SIRS), can be detected by simple bedside vital signs and a rapid blood test called a CBC with differential.  Once a patient is deemed to be septic, i.e., has the signs of SIRS caused by an infection, a standard treatment regimen of antibiotics, fluid resuscitation and eliminating the source of infection is started to stop the infection from progressing.

When the treatment of sepsis is delayed, the patient’s condition worsens.  Studies show that untreated sepsis will progress to compensated shock, then to uncompensated shock and then to organ failure.  At each step of the progression, the patient’s chance of dying increases.  At some point, a septic patient reaches a “point of no return” and they will die from the condition even if treatment is started.  Physicians agree: early treatment of sepsis saves lives.

Under Ohio law, a medical malpractice case can arise in this context when there is a delay in treatment caused by a physician’s failure to properly test for infection, failure to timely start appropriate treatment or ignoring positive test results.  In the case reported by the New York Times, the boy’s blood test results showed a high band count, also known as a “bandemia,” which signifies that the body is creating young white blood cells to fight infection.  This result was ignored, and the boy was sent home prematurely.  You can read more here: http://www.nytimes.com/2012/07/12/nyregion/in-rory-stauntons-fight-for-his-life-signs-that-went-unheeded.html?_r=1&hp.

In my experience, doctors are prone to make errors in judgment by deviating from the standard diagnostic technique used by all physicians, the “differential method.”  Using the differential technique, a physician creates a list of potential diagnoses.  When tests rule out a potential diagnosis, they cross that off and move on to the next one until the correct diagnosis is made.  However, physicians will often skip steps and jump to conclusions without taking into account test results or all of the patient’s signs and symptoms.

This shortcutting seems to happen more frequently in certain situations:  when patients present on evenings, weekends or holidays and thus are seen by less experienced or busier physicians; when patients present with an atypical constellation of symptoms (e.g., an abdominal infection without abdominal pain), or; when patients do not fit the usual profile of the disease (e.g., women with heart attacks or, as in this case, young people with sepsis).  The differential method is designed to avoid diagnostic errors.  It works, unless it is bypassed by a arrogant, inexperienced or uncaring physician.  In those cases, hospital infections will go from bad to worse.

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By Howard Mishkind|2019-04-24T18:00:00+00:00July 12th, 2012|Hospital Infection, Hospital Negligence|Comments Off on Another Example of Delayed Diagnosis of Hospital Infections
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