Coronial
VIChospital

Finding into death of Iman Kassis

Deceased

Iman Kassis

Demographics

46y, female

Date of death

2008-10-09

Finding date

2014-09-30

Cause of death

hemopericardium secondary to dissection of the thoracic aorta

AI-generated summary

Iman Kassis, a 46-year-old woman with Ehlers-Danlos Syndrome Type 4 and known severe aortic regurgitation with dilated ascending aorta, presented to the ED on 8 October 2008 with sudden-onset severe throat pain, bradycardia, and right arm weakness. She was discharged after 4 hours observation with a diagnosis of gastro-oesophageal reflux disease. She died at home hours later from hemopericardium secondary to thoracic aortic dissection. The coroner found her death preventable: aortic dissection should have been explicitly considered and documented as a differential diagnosis before settling on a benign explanation. Best practice requires clinicians to convincingly exclude aortic dissection in patients with chest pain, particularly those with predisposing connective tissue disorders. Poor documentation of her observation period and vital signs after 2pm hampered assessment of clinical decision-making. With timely diagnosis and treatment, Ms Kassis had a reasonable chance of survival.

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

Specialties

emergency medicinecardiologycardiothoracic surgeryforensic medicine

Error types

diagnosticdocumentationcommunication

Drugs involved

flecainidetramadolpenthraneparacetamol/codeineomeprazoleranitidinemetoclopramide

Clinical conditions

aortic dissectionhaemopericardiumaortic regurgitationdilated ascending aortaehlers-danlos syndrome type 4supraventricular tachycardiabradycardiagastro-oesophageal reflux diseasemorbid obesityobstructive sleep apnoeahypertensionpulmonary hypertension

Contributing factors

  • Ehlers-Danlos Syndrome Type 4
  • severely dilated ascending aorta
  • aortic regurgitation
  • failure to consider aortic dissection in differential diagnosis
  • atypical presentation for aortic dissection
  • inadequate documentation during observation period
  • discharge without definitive imaging to exclude aortic pathology

Coroner's recommendations

  1. Clinicians should explicitly consider and convincingly exclude aortic dissection in the differential diagnosis before arriving at other more benign diagnoses, particularly in patients presenting with chest pain and those with medical histories predisposing to aortic dissection
  2. The differential diagnosis of aortic dissection should be documented in medical records, along with the rationale for excluding it as a diagnosis
  3. Clinicians should focus on known predisposing factors such as hypertension and connective tissue disorders such as Marfan's syndrome and Ehlers-Danlos syndrome when considering aortic dissection
  4. Medical records documentation should be improved, particularly documentation of observation periods, vital signs, pain resolution, and clinical decision-making in short stay units
Full text
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Source and disclaimer

This page reproduces or summarises information from publicly available findings published by Australian coroners' courts. Coronial is an independent educational resource and is not affiliated with, endorsed by, or acting on behalf of any coronial court or government body.

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