Inquest into the death of Alexander Costello

AI-generated summary

Alexander Costello, 37, presented to Gunnedah Hospital ED with acute onset severe chest pain, back pain, diaphoresis and nausea. Dr G., the sole ED physician, conducted initial assessment including ECG and troponin testing, both normal. He diagnosed gastritis and admitted for observation. Costello collapsed in shower that evening and died from Type A aortic dissection with haemopericardium. The coroner found several failures in clinical care: family history of aortic dissection was inadequately documented despite being communicated; aortic dissection was not considered as a differential diagnosis despite being listed in the NSW Chest Pain Pathway; clinical notes lacked timestamps and detail; the Chest Pain Pathway was not appropriately utilised. The coroner concluded that at 3:30pm, after negative troponin results, aortic dissection should have been considered and transfer to Tamworth arranged. However, even with optimal transfer and surgical management, Costello likely would not have survived given the complexity of Type A dissection repair. Key learning: maintain high index of suspicion for aortic dissection in acute severe chest/back pain; properly document family history; systematically consider differential diagnoses including rare but catastrophic conditions.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.