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A Sneaky Surgical Emergency: Acute Compartment Syndrome. Retrospective Analysis of 66 Closed Claims, Medico-Legal Pitfalls and Damages Evaluation

August 25, 2020

Litigation

Proper management of Acute Compartment Syndrome minimizes or avoids the sequel associated with a late diagnosis and may reduce the risk of malpractice claims. As acute compartment syndrome is a clinical emergency, early findings are crucial.

Abstract

Acute compartment syndrome (ACS) is a clinical condition with potentially dramatic consequences if it not diagnosed early. Good management of ACS minimizes avoids the sequel associated with a late diagnosis and may also reduce the risk of malpractice claims. The goal of this study was to evaluate different errors ascribed to the surgeon to identify how the damage was elevated. This current study is a further step in the analysis of malpractice claims.

Brief Case Description

The treatment of ACS often comprises plastic surgery, traumatology, and other main surgeries. Among the various medical and surgical procedures that are the object of litigation, ACS still represents a high-risk situation for both the patient and the healthcare provider. This syndrome develops rapidly from the onset of symptoms to the establishment of irreversible damage. Clinicians tend to change the pathological evolution of the syndrome by adopting certain strategies. Even if various examinations to aid the clinical diagnosis of compartment syndrome are available, measurement of intra-compartmental pressures (ICP), using the STIC pressure monitor, is still the most reliable method.

Intervention and Outcome Summary

Clinical surveillance from the medical staff is necessary when ACS is a considered diagnosis. In result of a delayed diagnosis, a total of 48 out of 66 cases resolved from the verdict of iatrogenic damage. A total of $394,780 out of $574,680 derived from medical error. Nevertheless, recent studies have demonstrated that ICP data (particularly single readings) must be interpreted in view of clinical findings and clinical assessment is still the diagnostic cornerstone of ACS. Given that errors of diagnosis of ACS are preventable through continuous monitoring of the patient, it is important to consider that this type of iatrogenic injury often represents an avoidable cost.

Original Publication:

International Journal of the Care of the Injured

Authors:

M. Marchesi, A. Marchesi, G.M. Calori, R. Zoia, L. Vaienti, O.Morini

 
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