Error in Ruling Out Pulmonary Embolism in Stable Patient

///Error in Ruling Out Pulmonary Embolism in Stable Patient

Error in Ruling Out Pulmonary Embolism in Stable Patient

Misdiagnosis of pulmonary embolism (PE) is a common basis for medical negligence actions.  The problem arises because PE can masquerade as other medical conditions such as heart attack or sepsis.  It is erroneous to make assumptions about common symptoms like shortness of breath and chest pain without doing a proper and thorough workup.  Oftentimes, this means working up several potentially life-threatening conditions at the same time.  A recent article published in Academic Emergency Medicine points to another pitfall: curtailing the investigation when the patient’s vital signs stabilize.

Common signs of pulmonary embolism include shortness of breath, fast breathing, chest pain, cough and coughing up blood.  Not all symptoms must be present and they may wax and wane.  These symptoms typically have rapid onset, but not always.  Further complicating matters is the fact that various other conditions share some of these symptoms, like pneumonia, myocardial infarction (MI) and sepsis. Also, patients may have more than one of these conditions at the same time.  So, in order to be safe, a thorough workup is mandatory when the clinical symptoms and risk factors raise concerns about pulmonary embolism.

To rule PE in or out, doctors may start with a simple blood test called a d-Dimer.  This test is good at ruling out PE but not good at establishing it as the diagnosis.  The gold standard for diagnosing PE is pulmonary angiography, a radiographic test that uses CT imaging with dye to show whether clots are blocking portions of the lungs.  Before these tests are performed, the physicians must establish a clinical suspicion for PE.

The Academic Emergency Medicine article points out that some physicians may give up on investigating PE if the patient’s vital signs normalize during the hospital visit.  The article indicates that the incidence of PE is the same for patients whose vital signs normalize.  Therefore, just as a normal blood gas value does not rule out acute PE, stabilization of abnormal vital signs does not reduce the likelihood of PE.  The authors counsel that abnormal vital signs occurring at any time after symptom onset should factor into determining pretest probability of PE, even if they subsequently normalize.  In Ohio, if a physician rules out PE based on the faulty premise that the patient’s vital signs improved, and harm occurs, there may be a basis for a medical malpractice or wrongful death claim.

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By |2019-03-18T22:02:40+00:00February 12th, 2013|Pulmonary Embolism|0 Comments

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