This case involves an elderly female patient in otherwise good health who was still working, driving and living independently when she suffered a trip and fall accident in the parking lot of a major big box retailer. She sustained a knee injury, as well as a fracture of her left arm. The woman’s treating orthopedic surgeon instructed her to avoid work and any strenuous activity; as a result, the woman became sedentary at home. While she was in otherwise good health, the woman had been taking medication to control her blood pressure and cholesterol. Two weeks later, the woman called an ambulance after collapsing at home and was taken to the hospital, where she was diagnosed with a pulmonary embolism as well as atrial fibrillation. She was treated using Xarelto but the course of the patient’s recovery has since proven to be complicated, with multiple hospital stays. It was alleged that the patient’s change to a sedentary lifestyle following the accident was a direct cause of her deteriorating health.
Question(s) For Expert Witness
- 1. Do you have experience treating patients who have sustained similar injuries due to accidents of this nature?
- 2. How common is it for patients to develop these sequelae after an accident?
Expert Witness Response E-048014
In my clinical practice I have treated patients with deep vein thrombosis and atrial fibrillation. There are studies that show that immobilization after trauma increases the chance of venous clotting and pulmonary embolism. In a large study, 45% of patients with venous thromboembolism had more than 48 hours of immobility in the preceding month. Minor injuries may increase the rate for developing venous clotting and subsequent embolism. Another study revealed that 11.7 of nearly 2500 patients had a minor injury in the three months preceding the venous thrombosis compared to 4.4% of controls. It may have been the case that this patient’s shift to a more sedentary lifestyle contributed to her eventual illness.
Expert Witness Response E-009363
I have taken care of patients who have sustained orthopedic injuries after falls or trauma. In the care of such patients, questions related to functional limitation naturally arise; immobility may be necessary to facilitate repair but is a risk factor for pulmonary embolism. In addition, I have spoken and written about the use of anticoagulants in the face of trauma. In my practice, I have an interest in anti-thrombotic therapy and am involved in studying its use in patients with heart disease, atrial fibrillation, deep vein thrombosis, and pulmonary embolism.