An inquest into the deaths of two people in South Australia from deep vein thrombosis (DVT) has recommended a shake-up of the way the condition is diagnosed, including greater consideration of long-haul air travel as a risk factor.
Philip John Byrne, 52, and Jacqueline Weaver, 63, died suddenly in February 2012 and October 2013 respectively.
Mr Byrne and Ms Weaver had earlier complained of leg pain to GPs and a physiotherapist.
Neither was known to each other, but deputy coroner Anthony Schapel conducted concurrent inquests because of “a number of features of commonality between the causes and circumstances of their respective deaths”.
The inquest heard that, in both cases, a blood clot – or deep vein thrombosis – travelled from the patients’ legs and jammed in their lungs.
Mr Schapel found their deaths were preventable and DVT should have been diagnosed.
“In neither case was the pulmonary embolus diagnosed prior to death. Nor was the risk of it identified,” he said.
Mr Schapel said that, in the period leading up to their deaths, both had symptoms “including calf pain that was possibly suggestive of … deep vein thrombosis, a well understood possible consequence of which is a fatal pulmonary thromboembolus.”
He said the inquest demonstrated a limit to reliance on the Wells Score System, which is used worldwide, for deciding the likelihood of DVT.
Mr Schapel said the version of the Wells Score System presented to the court did not consider previous history of DVT as a risk factor, and advised GPs “not to place undue reliance” on it.
“The use of this particular document in other than hospital settings may require re-evaluation in the light of these two cases,” he said.
Long-haul air flight a ‘risk factor’ in DVT
The inquest heard Ms Weaver was a “seasoned international traveller”, and she had travelled in June and July 2012.
“The long duration of the flights at least constituted a risk factor for the development of DVT, as is well known,” Mr Schapel said.
The deputy coroner concluded that, when Ms Weaver went to see a doctor in August 2012, “she was experiencing a DVT and that the left calf pain of which she complained was a symptom of that DVT”.
He recommended that flight should be taken into account by doctors as a possible cause of DVT.
“Any version of the Wells Score System should in the opinion of the court certainly make reference to the risk factor of recent long-haul air travel and previous history of DVT.”
Mr Schapel also recommended that:
- advice and education be delivered to all general practitioners, physiotherapists and other like health care practitioners concerning the signs and symptoms of DVT and pulmonary embolus
- advice [be provided] that DVT within the leg of a patient may not exhibit all of the classic signs and symptoms at the same time
- general practitioners be advised to consider the possibility of the existence of DVT in all cases of calf pain and not to exclude such a diagnosis on the basis of clinical signs and symptoms alone