Finding into death of Kevin John Harris

38y · Male·Pulmonary thromboembolism in the setting of deep vein thrombosis

Kevin Harris, a 38-year-old man with obesity, sustained a left tibial plateau fracture from a workplace fall on 27 December 2022. His general practitioner managed the injury conservatively with rest, ice, and anti-inflammatory medication, then ordered an MRI after 6 days when pain persisted. The MRI confirmed the fracture, and physiotherapy was recommended. Kevin remained immobilised and non-weight-bearing. On 11 January, his family noted increased knee swelling and shortness of breath. He was found deceased on 12 January. Autopsy revealed pulmonary thromboembolism secondary to deep vein thrombosis, with contributing factors being the fracture, immobilisation, and obesity. The coroner found the GP's management reasonable given the absence of clear clinical guidelines for VTE prophylaxis in general practice settings and Kevin's lack of DVT symptoms during consultations. The coroner recommended RACGP develop clinical guidelines for VTE management in primary care.