Medical Malpractice Bulletin – December, 2015

Perspective: Radiology discrepancies: What’s the “miss rate”? Who’s responsible?

By Charles A. Pilcher MD FACEP
December, 2015
How often does a radiologist miss an x-ray finding? What happens when they do? Should ordering physicians view all images themselves? What if there’s a disagreement? Who’s responsible? Can we determine a standard of care? When there’s a “miss,” what procedures and guidelines should be followed? These questions are frequently part of malpractice litigation. CONTINUED ->

New test may shave hours or days off the diagnosis and treatment of meningitis
The FDA announced in October that it will allow marketing of a new test may on spinal fluid (CSF) that will speed up the diagnosis and treatment of meningitis or encephalitis significantly. The test (FilmArray ME Panel) uses a nucleic acid method and identifies any of 14 bacterial, viral and yeast pathogens simultaneously in about 1 hour. It should be used in conjunction with other clinical and laboratory findings. Cultures, which may take days to weeks, should still be done for confirmation, determine sensitivity to treatment and because less common causes of CNS infections will not be identified by the new test. For more on the test and a complete list of the pathogens identified, click here
[Editor’s Note: A team from Columbia University is perfecting a new test that “can find every virus in a few drops of any body fluid with near perfect accuracy.” Stay tuned. /cp]

Misdiagnosis of abdominal pain in the ED: Why?
A study of the reasons for misdiagnosis of abdominal pain in the ED was just published in the BMJ Emergency Medicine Journal. Not surprisingly, Dr. Laura Medford-Davies et al. from Baylor University found that the major causes of misdiagnosis included incomplete or incorrect history or exam, failure to order needed tests to determine the cause of pain and failure to follow up on abnormal test results. With abdominal pain being one of the most commonly mis-diagnosed problems leading to litigation, identifying correctable sources of error is a high priority. [Editor’s Note: There’s little real “news” in this study. Most med mal attorneys have known of this pattern for decades. /cp]

Endovascular thrombectomy for stroke: Breakthrough or hype?
Badhiwala et al. reported last month in JAMA on the outcomes of intravascular thrombectomy (clot retrieval) from victims of stroke and compared them with standard therapy using tPA. Over 2400 patients were included. More patients (44.6%) were functionally independent at 90 days with thrombectomy than with tPA (31.8%), a difference of 12.8%. Angiographic revascularization was 75.8% at 24 hours with thrombectomy and 34.1% with tPA. There was no difference in symptomatic intracranial hemorrhage, about 5.5%, or all cause mortality (about 16%). Thus, it appears that benefits of thrombectomy are greater than the benefits of tPA without increasing the risks. [Editor’s Note: The biggest problem with thrombectomy is that few (~6%) of stroke patients have a clot in a vessel that is amenable to extraction and few hospitals are equipped well enough at all times to perform the procedure. With most hospitals able to treat stroke patients early with tPA, the question will be “Does it make clinical and economic sense to transport 16 ineligible patients to a thrombectomy stroke center to benefit 1 eligible patient?” / cp]

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