Medical Malpractice in the Management of Angioedema: A Multidisciplinary Westlaw Analysis.

Abstract

Background: The management of acute angioedema is challenging and involves providers in multiple specialties. Timing of evaluation and intervention is imperative and requires effective communication between these groups, as treatment delays and improper management can lead to airway compromise and death. We aim to identify factors that contribute to malpractice litigation in the management of angioedema.

Materials and methods: The Westlaw comprehensive legal database was queried for angioedema malpractice cases from 1993 to 2022. Angioedema misdiagnoses were excluded. Root cause analysis was conducted and cases were classified by defendant specialty, claimed liabilities, complication, verdict, and damage amount awarded.

Results: Nine cases of angioedema malpractice were identified and met inclusion criteria. Eight cases (89%) resulted in patient death due to cardiorespiratory compromise secondary to loss of the airway, with one case resulting in long-term brain damage. Root cause analysis revealed 67% of cases involved failure to establish a timely airway, 56% delayed treatment, 33% failure to diagnose, and 33% improper treatment. Forty-five percent of the involved practitioners were emergency physicians; primary care and anesthesia were each implicated in one case. Five (56%) cases ruled in favor of the defense. Average damage amount was $3,794,000. In each case, there was significant delay in the involvement of Otolaryngologists for airway evaluation.

Conclusions: Angioedema is a challenging disease for which management requires active monitoring and coordinating of care between several medical teams. This study identifies late involvement of airway experts in patient management and risk stratification as a risk factor for litigation and poor outcomes.