This case involves an elderly female patient who was still working, driving and living independently when she suffered a serious injury in a car accident. On the date of the incident in question, the Plaintiff was driving home from the grocery store when a pickup truck ran a red light and struck the driver side door of her car. As a result of the accident, the Plaintiff suffered a number of fractures on her left side, including a broken arm, broken ribs, and a serious knee injury. The Plaintiff’s physician recommended that she abstain from all strenuous activity and work for an extended period of time in order to heal. Previous to this order, the Plaintiff had been highly active, went for regular walks, and exercised almost daily. Some time after the accident, the Plaintiff was admitted to the hospital for a pulmonary embolism, during which time an additional diagnosis of atrial fibrillation was made. As a result of these new health issues, the patient was placed on Xarelto and forced to move to a nursing facility while doctors considered administering a pulmonary vein isolation and ablation procedure. It was claimed that the patient’s change in lifestyle after her car accident was responsible for her cardiovascular issues.
Question(s) For Expert Witness
- 1. Do you have experience treating patients who have sustained similar injuries due to motor vehicle accidents?
- 2. How common is it for patients to develop these sequelae after a motor vehicle 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 is certainly possible that this patient’s immobility after her accident exacerbated these cardiovascular symptoms.
Expert Witness Response E-000592
I have extensive experience treating patients similar to the on described in the scenario. It is not common for patients to develop this outcome with minimal injury. From the information provided, it is not clear the exact extent of the patient’s injuries and how immobile she was after being seen by the orthopedic surgeon. There is, however, an increased risk of developing these sequelae with decreased mobility.