Author: Chuck Pilcher, MD FACEP (Editor, Med Mal Insights) // Editors: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)
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Chuck Pilcher, MD, FACEP
Editor, Med Mal Insights
Don’t over-simplify a complex case
Multiple risk factors deserve a thorough workup for endocarditis (SBE)
Facts: A 13-year-old male presents with fever, backache, and headache. He has a history of transposition of the great vessels with surgical repair, recent stent placement, and prior endocarditis. No tests are done. He is diagnosed with a viral syndrome and sent home on ibuprofen. Two days later he returns with the same complaints, is admitted, and antibiotics are started. Blood cultures are positive for Staph aureus. His hospital course is long and complicated, resulting in brain damage and left sided hemiparesis.
Plaintiff: My heart defect and prior endocarditis made me high risk for repeat SBE. The first physician should have admitted me and obtained blood cultures. A cardiology consult should also have been obtained.
Defense: You’re probably right. Let’s settle.
Result: Settlement for $17 million.
Takeaways:
- Patients with complex histories deserve more than simple evaluations.
- A patient with a history of heart surgery, endocarditis, and coronary artery stents is a bouquet of red flags.
- Carefully consider red flags for endocarditis in patients with fever or flu-like illness.
- Save your simple assessments for straightforward patients.
- If you are not the PCP, try to contact him/her for high risk patients to discuss the evaluation and management, as well as to obtain follow up.
References:
– Infective Endocarditis. Brusch JL, Medscape eMedicine, October 16, 2017. https://emedicine.medscape.com/article/216650-overview
Failure is the key to success; each mistake teaches us something.
Morihei Ueshiba
