Malpractice Litigation: Compartment Syndrome
John Phair, MD1, Matthew Carnevale2, Karan Garg, MD1, Evan Lipsitz, MD, MBA1, Larry Scher, MD1.
1Montefiore Medical Center, Bronx, NY, USA, 2Albert Einstein College of Medicine, Bronx, NY, USA.
Objective: To analyze malpractice litigation trends and better understand the outcomes of compartment syndrome cases.
Methods: Jury verdict reviews from the WESTLAW database from January 1st 2010 to January 1st 2018 were reviewed. The term “compartment syndrome” was used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict.
Results: A total of 256 cases were identified. Incidentally included duplicates and civil cases were excluded from the analysis. 124 cases involving the diagnosis of compartment syndrome were identified. Hospitals were involved as a defendant in 51.6% of cases. The most frequent physician defendants were orthopedic surgeons (45.96%), emergency medicine physicians (20.16%), and cardiothoracic/vascular surgeons (16.93%). The most frequent causes of compartment syndrome were trauma (27.41%), IV extravasation (9.67%), vascular thrombosis or ischemia (8.87%), iatrogenic injury during orthopedic surgery (6.45%), and iatrogenic injury from cast or positional placement (4.03%). Fifty cases (40.32%) involved a diagnosed arterial injury and 31 cases (25%) involved a diagnosed fracture. Thirty-seven cases (29.83%) included fasciotomy as part of the treatment. Region of injury was lower leg (54.03%), arm (31.45%), and abdomen (8.87%). Injury was listed as nerve damage (33.87%); either paralysis or foot drop, major amputation (14.52%), death (11.29%), and complex regional pain syndrome (5.64%). Most claims were due to failure in diagnosis (71.77%), negligent surgery (39.52%), and delay in diagnosis (44.35%). In seven cases (5.6%) expert witnesses concluded that a vascular consultation was indicated however treating physicians failed to order them. Five out of those seven cases were found for the plaintiff. A total of 40 cases (32.25%) were found for the plaintiff or settled; with average awards $1,553,993.66 (1,193,059.25 - 1,914,928.07). Fifteen (37.5%) of these cases had an injury of nerve damage and 7 (17.5%) of major amputation.
Conclusion: There are no current studies evaluating compartment syndrome and possible subsequent litigation. We offer a brief overview of the most common defendants, plaintiffs, and injuries involved in these legal disputes. Orthopedists are particularly at risk; however vascular surgeons may also be involved in these cases due to the large number of arterial injuries present.
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