WINDOW OF OPPORTUNITY

Where prevention or treatment can reverse, arrest or mitigate the outcome of a disease process, Quantum of Damages commonly arises from the consequences of later rather than earlier diagnosis. 

In some medical conditions, the opportunity to intervene may be time-limited.  Absent timely diagnosis and treatment of these disease processes, either a severe complication will likely occur, or tissue damage becomes irreversible.

The window of opportunity to intervene may vary from minutes to days, depending on the medical condition.   

Before a complication occurs

Appendicitis, if not operated on, commonly proceeds to perforation. The progression to perforation usually takes many hours¹ and this complication does not invariably occur. 

Leaking of blood from aneurysms, both cerebral and aortic abdominal causes pain - headache or abdominal pain.  Such leakage is commonly followed by more major bleeding that may result in brain damage and/or a threat to life. 

While neonatal herpes is limited to the skin, eyes and mouth, more widespread infection, including brain-damaging encephalitis, can be prevented by the intravenous administration of the antiviral agent acyclovir².

If severe, pre-eclampsia must be recognised and treated by early termination of pregnancy (childbirth or therapeutic abortion) if progression to life-threatening eclampsia is to be avoided. 

While tissue damage is reversible

Brain

Severe hypoglycemia may cause brain damage within minutes³. 

Stroke thrombolytic therapy must be started within 3 hours⁴ if administered intravenously or within 6 hours if administered directly into the affected artery⁵. 

For cardiopulmonary arrest there is experimental evidence⁶ why the heart must be restarted within 5 minutes if neurological damage is to be avoided^{7 []}.  . 

Intrapartum asphyxia will damage the fetal brain within 1-2 hours if acute⁸, though the window of opportunity for intervention is much smaller if there is already mild chronically compromised oxygen supply to the brain. 

Nerves

Acute cauda equina syndrome causes permanent neurological damage if not relieved surgically within 24-48 hours

Heart

Unstable angina and coronary thrombosis require medical or surgical intervention within 6 hours if permanent damage to heart muscle is to be avoided⁹

Eyes

Retinal detachment must be corrected surgically within 10 days if the macula is involved, though optimally within 24 hours¹⁰. 

Depending on the virulence of the infection, it may be as little as 24 hours before endophthalmitis causes permanent loss of vision¹¹.

Limbs

The window of opportunity for intervention in acute worsening of peripheral vascular disease depends on the specific clinical circumstances, but on occasions may be only a few hours¹². 

To minimise the resulting injury

Occurrence and severity of brain damage caused by meningitis depends on the virulence of the infecting organism.  For some varieties of meningitis it may be possible to show that a delay in diagnosis probably worsened the injury. 

Sepsis that is treated before progression to severe sepsis and septic shock may leave little or no residual damage.  Development of the severer stages of widespread infection increases the probability of permanent damage or death. 

Necrotising fasciitis will always leave a degree of pathological and surgical damage, and only the amount of injury will be determined by undue delay in diagnosis and treatment. 

Delay in diagnosis of breast carcinoma and other malignancies may or may not materially alter the treatment, life-expectancy and probability of cure. 

Ruptured spleen will likely require the same surgical treatment - removal or repair - whether or not diagnosed promptly.  However, missed diagnosis may result in death from exsanguination. 

Severe acute hemorrhage from many other causes can be life-threatening and may result in permanent injury or death if not treated promptly.