It is not often that an error in the ER costs the life of the patient.
But not completely extraordinary either.
The largest study carried out in Spain (from 2010) calculated that intervention errors in these units resulted in death in approximately one in every 4,000 cases.
In the absence of an investigation to determine the facts, it seems to be the case of Emma Martínez Gascón, a 12-year-old girl who died on Monday at the Hospital Clínico de Valencia due to peritonitis without the doctors detecting it.
According to the study, 70% of all "adverse effects" caused by emergency interventions are preventable and 54.6% are due to failure or negligence in diagnosis.
Emma did not have the necessary tests, despite the fact that her mother, according to what she told EL PAÍS, insisted that it could be an appendicitis (which can lead to peritonitis) due to family precedents.
Several experts in pediatric emergencies consulted explain that not detecting appendicitis is one of the most frequent serious errors in pediatrics, although it is not normal for them to have a fatal outcome.
"For this, many failures must occur at the same time and it is rarer," say these sources, who prefer not to be cited so as not to interfere in the Valencia investigation.
What happens is that the vast majority of appendicitis present with the classic presentation: abdominal pain located on the right side that is usually accompanied by some fever.
The problem comes in those rarer cases where the symptoms change.
“Appendicitis in a retrocecal position is a diagnostic challenge for pediatricians because it takes longer to show symptoms and the pain is not located in the right iliac fossa, like most.
In addition, due to their position, they frequently associate diarrhea that can be confused with gastroenteritis and sometimes urinary symptoms similar to a urine infection”, explain the pediatricians consulted.
An added difficulty is that the patient with appendicitis (or peritonitis) is a very young child, in which it is very rare,
In more doubtful cases, explains Pascual Piñera, vice president of the Spanish Society of Emergency and Emergency Medicine (SEMES), an ultrasound and blood tests should be requested, which usually lead to an accurate diagnosis.
It's what didn't happen in Emma's case.
In recent years, some similar cases have emerged.
The community of Madrid was sentenced this year to pay 150,000 euros for the consequences of a girl, also 12 years old, for not being diagnosed or treated on time for peritonitis at the Niño Jesús University Children's Hospital in the capital.
In 2020, an eight-year-old boy died from the same ailment in Alicante after going to the emergency room five times and receiving hardly any treatment.
A few years earlier, in 2016, the family of Gabriel Pérez, a 24-year-old soccer player, reported that he had gone to the emergency room three times for abdominal pain that was diagnosed as gastroenteritis and gastritis.
They did not detect peritonitis until after three days and the young man died.
Peritonitis is also relatively common as a secondary complication of surgical intervention.
In 2021, for example, the Health of Castilla y León was ordered to pay 300,000 euros in compensation to the widow and two children of a 61-year-old man who underwent surgery in 2017 at the Valladolid Clinic who developed peritonitis that was not detected by time.
Cases like these dot the newspaper library from time to time, although it is very likely that most remain out of the spotlight.
More deaths than from suicides and traffic accidents
There is no study as powerful as the one from 2010 (with almost 4,000 patients) to know if things have improved since then.
With around 25 million emergency care in Spain every year, if those calculations continue to hold, they would translate into more than 12,000 deaths a year, more than 8,700 of which would be preventable, according to the study's calculation.
There are more deaths than those that in 2021 added suicides (4,003) and traffic accidents (1,599).
Traffic accident in Salobreña (Granada), on February 7. Alba Feixas (EFE)
Piñera believes that in this time the situation may have improved, but he is sure that it would do so resolutely with "regulated and uniform training for all emergency doctors."
SEMES has been demanding recognition of the specialty in MIR studies for years, which, in Piñera's opinion, would help "avoid or reduce the number of adverse events that occur as a consequence of daily clinical practice."
Another factor that contributes to increasing errors is the saturation of emergency services.
In the last year, society has been denouncing that the cases that reach them have increased between 30% and 50%, depending on the hospital and the time of year.
“When you have to see a high volume of patients and you have less time, it is normal for there to be more failures,” says Piñera.
This saturation has several causes.
One that all the experts consulted point out is the collapse of primary services in a large part of Spain.
When the entry to the system fails and it is necessary to wait several days for a consultation with the family doctor, citizens often go to the emergency room, where they know that, with more or less waiting, they will be treated the same day.
All these attentions, often banal, take time away from real emergencies.
The president of the Spanish Pediatric Emergency Society (SEUP), Paula Vázquez, explained in a report in this newspaper that there has always been a problem that many citizens go to the emergency room for non-urgent cases.
“But since the pandemic it seems that it has grown, either because the pediatrician has a waiting list and it takes a few days to see the child, or because people were reluctant to go to the health centers, which were saturated and now come directly to us. ”, he reasoned.
The SEUP created a traffic light that aims to help parents decide when it is time to call 112 for immediate assistance, when they should go to the emergency room more calmly but without delay, and when they can wait to see their pediatrician.
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