Coroner's Finding: BYRNE Philip John and WEAVER Jacqueline

Contributing factors

• failure to order diagnostic imaging (ultrasound) despite suspicion of DVT
• reliance on clinical examination alone to exclude DVT
• misreading of clinical notes regarding previous DVT history
• failure to consider DVT as differential diagnosis despite unexplained symptoms
• lack of enquiry about risk factors (long-haul air travel, previous DVT, hormone replacement therapy)
• inadequate communication between general practitioners and physiotherapist
• inappropriate application of Wells Score System without considering important risk factors
• attribution of symptoms to alternative benign diagnoses without adequate explanation

Coroner's recommendations

1. Draw these findings to attention of Royal Australian College of General Practitioners, South Australian Branch of Australian Medical Association, Physiotherapy Board of Australia, and professional bodies of chiropractors and osteopaths
2. Deliver education to general practitioners, physiotherapists and allied health practitioners regarding signs and symptoms of DVT and pulmonary embolus, emphasising that classic signs/symptoms may not all be present simultaneously
3. Advise general practitioners not to place undue reliance on Wells Score System, particularly noting its omission of relevant risk factors (long-haul air travel, previous DVT history) and lack of guidance on symptoms of pulmonary thromboembolism
4. Royal Australian College of General Practitioners to develop specific guidelines for diagnosis of DVT and pulmonary thromboembolism in general practice, prescribing low threshold for diagnostic imaging and/or D-Dimer testing where no clear explanation exists for calf pain
5. Advise general practitioners to consider DVT possibility in all calf pain cases and not to exclude diagnosis on clinical grounds alone
6. General practitioners and physiotherapists to thoroughly explore: risk factors including recent long-haul air travel; symptoms attributable to both DVT and pulmonary thromboembolism (chest pain, palpitations, shortness of breath); possible explanations including recent trauma
7. General practitioners to accord significant weight to opinions of other healthcare practitioners (physiotherapists) and communicate with them about DVT/pulmonary embolism concerns where no obvious cause exists
8. Family members of Mr Byrne and Mrs Weaver should seek medical advice regarding screening for inherited thrombophilias