Archives for August 22, 2005

ACEP becomes more relevant: Case Report on Back Pain

ACEP announced a year or two ago that they would, as a professional society, review expert witness testimony to determine if it met the Societies’ standards for accuracy.  Now their first review is out, and it’s interesting to read. 

The medical case looks like one of those ?what? cases we’re all familiar with, when a patient presents with one thing and has a bad outcome of something unrelated.

I’m going to abstract those things I found pertinent(I wound up putting the whole thing here), and make a couple of comments:

A postmenopausal African-American female patient presented to the
emergency department with a chief complaint of fairly persistent pain
"inside her back" for two days prior to her evaluation. While the
patient did not verbally describe the location of her pain, nurses
noted that the patient pointed to her low back as she described the
pain. The patient attributed her pain to "overexerting" herself doing
yard work two days prior to evaluation. She also reported a history of
nausea of unknown duration.

Upon her presentation, the patient’s pulse was 104 and her blood
pressure was 157/110. Her height was 5′ 0" and her weight was 270
pounds. She had no SOB or diaphoresis.

Okay, big, round, back pain.  Very common ED complaint.

The patient’s medical history included hypertension and obesity. She
had a positive family history for atherosclerotic heart disease.

The physician’s examination of the back showed no abnormalities. The
pain was unable to be reproduced with bedside maneuvers. The remainder
of the physical examination was not discussed in the depositions. A
urinalysis showed 1+ bacteria.

Okay, so we’re not really second-guessing the medical care here, we’re looking at whether the expert witness testimony meets ACEP standards.

The patient’s pain resolved without intervention. She was apparently discharged home with Lortab and Motrin.

On discharge, the patient’s BP was 140/90 and her pulse was 80.

That’s not bad, at all.

The following day, the patient’s husband found her poorly
responsive. She was brought back to ER and later died from unknown

An autopsy was performed and showed that the patient’s heart was
hypertrophied and there was narrowing of coronary vessels. There was no
evidence of clot or plaque ruptures found in any of the coronary

This is a terrible, and from the presented information so far, completely unforeseeable event.  Now, bring on the plaintiff’s experts:

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