Medical Malpractice Insights: The 12 S-E-A’s of Christmas
- Dec 20th, 2023
- Chuck Pilcher
- categories:
Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives. If you have a story to share click here.
Chuck Pilcher, MD, FACEP
Editor, Medical Malpractice Insights
If you never want to miss a spinal epidural abscess, check out “The 12 S-E-A’s of Christmas,” a reprise of 12 medical malpractice cases first posted in December 2020 by Dr. Chuck Pilcher, the editor and publisher of a free monthly educational newsletter, Medical Malpractice Insights – Learning from Lawsuits.
Missed SEA’s were the genesis of Med Mal Insights. In 2014 I was asked by 4 different plaintiff attorneys to review 4 separate cases of a missed SEA, all in Washington State. It made me realize that we’re learning nothing from our most egregious mistakes, the ones that become lawsuits, especially those that get settled for $millions without a trial. We need to learn from those stories.
There’s no reason to miss an SEA. It’s a simple 3 step process:
1. THINK about it on every patient with spine pain. 99% of patients can be eliminated at this point.
2. Can’t rule it out (bounceback, risk factors, etc.)? Get an ESR and/or CRP (both is probably best). If those tests are normal and there are no abnormal neurologic findings, the patient is at very low risk of having an SEA. But your suspicion alone warrants closer followup than the usual back pain patient. That you considered an SEA, tested for it, and the result was negative is proof that you made a judgment call well within the standard of care.
3. If an ESR and/or CRP are elevated, there is a neurologic abnormality, or if you’re really concerned after step 1, get an MRI.
