Delayed diagnosis

caipin

I want to start by saying that my parents have no intention of going this route, they're just happy to have their daughter alive and well, so my post is purely out of curiosity.

So some years ago when my sister was 7 she was having severe headaches and vomiting for a few days. My mam brought her to the GP, who referred her to A&E, where they admitted her but sent her home the next day stating it was probably something viral and nothing to worry about. A scan was not performed (which is standard procedure when a child presents to A&E with headaches). I know this because I worked in A&E for a while and there's a huge sign on the triage room wall stating this.

The next day after returning home she fell unconscious and was rushed to hospital where they did the scan and found that there was an abscess on her brain. She was brought to Dublin where she had surgery and two subsequent ones as the abscess returned. She spent months in hospital and is now on medication for life to treat side effects.

So like I said, no one is interested in taking a case, I'm just curious to know if there is one to be made.

blairbear

It absolutely isn't standard procedure. NICE guidelines are used to determine whether a child is scanned or not, as well as overall clinical impression and physician gestallt. About 9 percent of traumatic head injuries are scanned in Ireland, less again for headaches. Generally space-occupying lesions present 1-2 times at an ED or GP service prior to diagnosis, with what could be benign symptoms (headaches; often due to dehydration, vomiting; could be a bug etc). Then all of the symptoms gradually coalesce and a more worrying picture presents itself.

A solicitor would ask for the medical notes and see if international best practice guidelines were followed.

I would LOVE to know what paediatric ED had this sign about CT brains! (I have worked in them as a doctor.) We have to discuss each CT with a consultant radiologist to see if it is appropriate. We try to limit the number of CT scans on children, unless clinically indicated. We do not perform them as a screening tool for headaches.

caipin

I'm not familiar with the guidelines so definitely bowing to your knowledge on this but I worked in this general ED for a short time as a student and remember that sign very clearly. Would certain hospitals have their own variation of a guideline?

blairbear

caipin wrote: »

I'm not familiar with the guidelines so definitely bowing to your knowledge on this but I worked in this general ED for a short time as a student and remember that sign very clearly. Would certain hospitals have their own variation of a guideline?

No. If one hospital scanned every single headache in a child it would be a national medical scandal. We all abide to the same practice protocols, particularly in paediatrics. We actually all use the same resource available online between the Irish Paeds EDs. If I suspend my disbelief and consider that that sign DID exist, I can promise you that it did not dictate the practice of the doctors in the hospital. Medicine is very standardised these days. And scans were even less freely available 10/20/30 years ago.

That being said, were I ever worried about an unstable child at any hour of the day or night and explained my clinical concerns, I can get a CT brain for them within minutes.

Peregrinus

As the discussion so far illustrates, this isn't really a legal question. Whether a scan was indicated for a child with the symptoms described is a question for the medics, not the lawyers. So I think we have started off in the wrong forum here.

Still, let's assume that a scan was indicated, but wasn't given. Now we begin to move into legal territory. It seems from the facts described in the OP that the failure to give a scan on day 1 resulted in one day's delay in diagnosing and, therefore, treating the condition.

Right. So the question that occurs to me is, did any injury result from this delay? Did it result in more invasive or more stressful treatment? Did it result in a poorer outcome for the patient? The months in hospital and the lifetime medication - would they have been avoided if treatment had begun a day earlier?

Obviously, we're back to medical questions again. But if the answer the medics offer is "there is no reason to think events would have unfolded differently", then I think a lawyer is going to say that, regardless of whether the day's delay was negiligent or not, you don't have much of a case here. If there was negligence, it hasn't caused you any damage.

hullaballoo

No harm, no foul.