Perspective: Spinal epidural abscess – Let’s find a way to stop this epidemic
By Charles A. Pilcher MD FACEP
April, 2016
Too many spinal epidural abscesses (SEA) are being missed. Too many patients are being paralyzed. Too little is being done to prevent these tragedies. It’s time for the medical and legal professions to figure out how to work together to prevent this. Suing doctors, then burying the results in non-disclosure clauses, is not working. I have waited to publish this “Perspective” on SEA’s for over 3 years but have not done so because I have been involved as an expert in one case or another throughout that time. Since the epidemic does not appear to be slowing, I can no longer wait. Patients continue to be unnecessarily harmed. By sharing this now, perhaps I can encourage our two professions to find a way to work together to improve patient safety. Attorneys reading this (whether defense or plaintiff), physicians and malpractice insurers, can do more than continue to close the barn door after the horse is out. Read the rest of my rant ->
[Editor’s Note: For the past two years I have been sending a newsletter like this to my physician colleagues. The purpose is to help doctors learn from the mistakes of others and improve patient safety. If you wish to view a recent issue, contact me.]
Cervical artery dissections: What’s the best treatment?
Cervical artery dissections (CAD) can involve the carotid or vertebral arteries and are an infrequent cause of stroke. They tend to present with more subtle symptom than a classic middle cerebral artery stroke because there may only be intermittent occlusion or residual circulation early in the course. If the dissection involves a branch of the carotid artery, the symptoms may resemble those of a typical stroke. However, if the dissection involves a vertebral artery, the symptoms may be only sudden onset of nausea with vertigo/dizziness. While the diagnosis should not be difficult to make – if one considers it – there remains dispute over the proper treatment once the diagnosis is made. The recently completed CADISS study published in Lancet asked whether anti-platelet therapy was better than anticoagulation and came to no conclusion as to which was better. Annals of Neurology has a useful article on stroke in patients presenting only with vertigo. And eMedicine by Medscape covers vertebral artery dissections here. While anticoagulation is usually considered standard treatment, there seems to be a lack of uniform consensus.
Necrotizing fasciitis and other SSTI’s a growing cause of lawsuits
Serious soft-tissue infections (SSTI’s) are an increasing source of medical malpractice lawsuits. Infections range from unrecognized abscesses to necrotizing fasciitis. If not recognized early they can lead quickly to major disfigurement, loss of limb and death. In particular, necrotizing fasciitis can proceed rapidly with case reports of death within 24 hours after minor surgical procedures or trauma. The hallmark of the disease is “pain out of proportion to the injury,” an obviously subjective marker but one that must be considered in all patients with such a complaint and a history of recent surgery or injury. Check out Medscape’s eMedicine website for a nice discussion of the disease. There’s also a report of a case with no preceding trauma in the Journal of the American Association of Physician Assistants here.
EHR’s continue to lead to medical errors
While electronic health records have been in use for some two decades, they have yet to fulfill all of their potential, and errors in diagnosis and treatment continue to be made, putting patients at risk. Kaiser Health News recently reported on a persistent – if not increasing – rate of these errors. Among the most common are:
- clicking the wrong box due to inattention or a slippery mouse
- missing key patient information by failing to access certain parts of the record, due to unfamiliarity with the record or time constraints
- entering information on the wrong patient when working on multiple patients simultaneously
- inattention to medication dosages
- disregarding alerts due to “alert fatigue”
The errors are often due to poor design of the EHR and confusing computer displays. The problem has recently been covered by several medical publications
To read the article in Kaiser Health News, click here.
To read another article in Healthline News, click here.
To read a 2013 Annals of Emergency Medicine report on the problem, click here.