Coronial
WAcommunity

Inquest into the Death of Adam David McKay

Deceased

Adam David McKay

Demographics

31y, male

Date of death

2003-01-23

Finding date

2005-05

Cause of death

Pulmonary thromboembolism arising from deep vein thrombosis

AI-generated summary

Adam David McKay, a 31-year-old geologist, died from pulmonary thromboembolism arising from deep vein thrombosis on 23 January 2003. He had recently completed extensive long-haul flights to West Africa and returned on 13 December 2002. On 14 December, he presented to his GP with right leg/calf pain after flying. Despite risk factors (obesity, long-haul travel), DVT was not investigated with ultrasound. When he presented five days later with resolved leg pain, ultrasound was not pursued despite discussion. He subsequently experienced shortness of breath attributed to asthma and chest infection. On 23 January, he deteriorated rapidly in hospital and died despite thrombolytic therapy. The coroner found that preliminary testing (D-dimer or ultrasound) for DVT in December would likely have been diagnostic and allowed anticoagulation before fatal embolisation. Key clinical lessons: diagnostic criteria may inadequately weight risk factors in frequent travellers; low clinical probability should not exclude testing where history and symptoms suggest thromboembolism; and elevated awareness of PE as a differential diagnosis is essential.

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Specialties

general practiceemergency medicinegeneral medicineintensive care

Error types

diagnosticcommunication

Clinical conditions

deep vein thrombosispulmonary thromboembolismright ventricular strainobesitychest infection (misdiagnosis)

Procedures

ultrasound (not performed)electrocardiogramchest X-rayarterial blood gas measurementintubationthrombolysis

Contributing factors

  • Failure to pursue ultrasound investigation of leg pain despite clinical suspicion of DVT in December 2002
  • Obesity (BMI ~36) not adequately weighted as risk factor
  • Long-haul air travel (35+ hours) not adequately considered as risk factor for DVT/PE
  • Recent additional air travel over Christmas period not documented in hospital records
  • Leg pain symptoms not linked to subsequent respiratory symptoms
  • Chest X-ray and ECG abnormalities misinterpreted as chest infection rather than PE
  • ECG showing S1Q3T3 pattern (right ventricular strain) not escalated for clinical review until late presentation
  • Diagnostic criteria (Wells) applied rigidly, resulting in no testing despite supportive history
  • Recent shorter domestic flights not documented as additional DVT/PE risk

Coroner's recommendations

  1. A Specialist General Practice group should review the practicalities of applying sensitive bedside D-dimer testing and appropriate diagnostic and therapeutic pathways for the diagnosis and management of thromboembolic illness within the scope of General Practice
  2. General Practitioners should be better informed in the area of ultrasound and D-dimer testing for DVT exclusion
  3. Continued elevation of awareness among medical officers and registrars of the constellation of relevant symptoms while taking note of relevant history should be maintained
  4. Consider D-dimer testing as an initial screening tool in general practice for patients with supportive history and symptoms, even when Wells criteria indicate low probability
  5. In Perth (geographically isolated region with high overseas travel rates), consider lower threshold for testing to exclude DVT in patients presenting with relevant history
Full text
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