This case takes place in Hawaii and involves a seventy-two-year-old elderly female patient who was involved in a car accident when the vehicle she was driving was struck by another car. The patient was seated in the front passenger side of the vehicle, which bore the brunt of the impact. She was rushed to the hospital via ambulance. As a result of the accident, the patient sustained multiple lacerations and abrasions to her lower limbs, fractured ribs and blunt force trauma to her entire body – especially a crushing injury on her right side. Prior to the accident, the patient had been living independently in her own home and was in reasonably good health. The patient was admitted to a medical unit for two weeks and subsequently required treatment at an inpatient rehabilitation unit for three weeks after discharge from hospital. The patient’s lower extremity skin integrity was compromised by the edema. Before the accident, she had symmetrical swelling and no leg lesions. Her legs continued to swell after discharge and the abrasions she sustained turned into weeping ulcers. Several days post-discharge she was diagnosed with cellulitis at a routine follow-up appointment. She was admitted to hospital for treatment of the cellulitis which included IV antibiotics and physical and occupational therapy. The patient, who was previously fully independent, never regained her pre-accident level of mobility and was no longer able to live independently, requiring close medical daily supervision.
Question(s) For Expert Witness
1. Is the geriatric population more susceptible to the development of unresolved cellulitis with complications such as those described in this case?
Expert Witness Response E-004446
Cellulitis most frequently occurs when there is a compromise in the skin's integrity, such as a laceration, insect bite, ulcers, surgical wound or a puncture wound. Cellulitis can also develop in patients with no skin injuries, as is the case in patients with chronic edema. A pre-existing infection of the skin can precipitate the development of cellulitis. Many patients suffer from edema, for many different reasons. Many patients have venous stasis and edema, lymphedema, or arterial insufficiency, which are the most common causes of unresolved cellulitis. The redness of the pooling of blood mimic infection, and in the case above, protracted infection is possible, but a combination of injuries from the accident to one or more of the circulatory systems noted above would be more likely to cause a refractory condition. This case could be a combination of factors, with vascular issues and the inability of antibiotics to penetrate into infected tissue due to circulatory compromise. The geriatric population is certainly more susceptible to all of the above, due to circulatory changes, and impaired immune responses associated with aging.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.