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Teachable Moment
Less Is More
October 2015

Preoperative Stress Tests—Superfluous Investigations Resulting in Excessive Treatment Delay: A Teachable Moment

Author Affiliations
  • 1Mazankowski Alberta Heart Institute, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
  • 2Department of Anesthesia and Pain Management, University of Toronto, Toronto, Ontario, Canada
JAMA Intern Med. 2015;175(10):1610-1611. doi:10.1001/jamainternmed.2015.4420

A man in his 70s was admitted with a right hip fracture following a mechanical fall. His medical history included controlled hypertension. Findings of cardiovascular examination were unremarkable, and peripheral examination revealed an externally rotated and shortened right leg with no vascular compromise. His electrocardiogram was normal. Prior to his fall, he was able to walk 2 to 3 miles a day, walk up several flights of stairs, and conduct moderate-intensity activities (such as golfing) without compromise. He gave no history of symptoms attributable to cardiovascular disease. The orthopedic team recommended an open reduction and internal fixation of his right hip.

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