Patient Discharged With Tracheal Stenosis

This case involves a thirteen-year-old male patient who was the victim of a drive-by shooting. The patient sustained a significant injury to the major vessels in the thorax, which required extensive thoracic surgery. After being stabilized, the patient was discharged. Two days later, he presented back to the hospital complaining of severe shortness of breath and wheezing. It was determined that the patient was discharged with narrowing of the trachea and subglottic stenosis. The patient went into cardiopulmonary arrest in the hospital and was resuscitated, but not before he sustained irreversible brain damage. The patient was transferred to a nursing home and was fully dependent for most aspects of daily living.

Question(s) For Expert Witness

1. What caused this condition and was this patient stable enough to be discharged?

Expert Witness Response E-000690

Acquired subglottic stenosis is secondary to localized trauma to subglottic structures. Usually, the injury is caused by endotracheal intubation or high tracheostomy tube placement. If irritation persists, the original edema and inflammation progress to ulceration and granulation tissue formation. This may or may not involve chondritis with the destruction of the underlying cricoid cartilage and loss of framework support. When the source of irritation is removed, healing occurs with fibroblast proliferation, scar formation, and contracture, leading to stenosis or complete occlusion of the airway. This patient should not have been discharged with this condition.