What happens when A&E miss a diagnosis?

A waiting room

In an average month, there are usually over 2 million visits to A&E and Emergency departments in England. In such a busy environment, it is not surprising that sometimes medical conditions are missed. Usually this won’t have a significant impact, but occasionally the consequences of a missed diagnosis can be more serious.

What can go wrong when A&E miss a diagnosis?

Jane is a child who lives at home with her family.  She had been feeling tired and had a headache and a high temperature for a few days.  Her family took her to her GP who referred her to hospital, where she was diagnosed with a chest infection and sent home with antibiotics.

A day and a half later she vomited in her bed several times and had a period of abnormal behaviour. For about 25 minutes she was looking but not following, her eyes were open but she seemed unaware of what people said and she did not respond to questions.  An ambulance was called but she then fell asleep and seemed OK when she woke 15 minutes later.  The ambulance team advised her family to take her to A&E.

Jane was admitted for observations but no further investigations were done.  Her family asked if she could have a head scan because they were concerned about her behaviour and symptoms, but the doctor said that there was risk of radiation from the CT scan and it wouldn’t be offered if it wasn’t necessary.   Jane’s family were advised that sometimes children with a high fever can have an unexplained event like a loss of consciousness.  She was again discharged home.

10 days later Jane started to get a swelling on her forehead.  Her GP referred her straight to the hospital where a swelling from the sinuses and bone infection of her skull were diagnosed.  She immediately had neurosurgery to relieve the pressure on her brain and to clear out the infection.

Whilst she recovered well from the operation she has had to have further surgery to insert  an artificial section of skull as the infection meant that her own skull section could not be replaced.  She has also suffered from damage to her frontal lobe.  This is the part of the brain that controls things such as emotional expression, problem solving, memory, language and judgment.   The impact of this is still ongoing and depending on the outcome she may need support for life.

A mannequin with the areas of the brain mapped on it

Making a claim for A&E negligence

Jane’s family approached Enable Law to investigate a claim.  We have obtained expert evidence that says that Jane’s family were correct to ask about a head scan.  Because of the history of attendance and the episode of non-responsiveness the A&E department should have arranged a CT scan.  This would have identified the building level of infection in Jane’s brain and had this been picked up on either her first or second attendance her brain damage and need for neuro-surgery would have been avoided.

We are now helping Jane’s family with support from our partner charities The Children’s Trust and Child Brain Injury Trust.  They are helping with input for Jane for her immediate needs.

We are also making a claim for damages for Jane so that she has funds to help her with her needs in the future.

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