North Manchester General Hospital admits liability for brain damage to child with undiagnosed infection
After issuing proceedings and receiving back an initial full denial of liability in prolonged pre-action clinical negligence protocol correspondence, Claire Horton secured a full admission of liability from Manchester University NHS Foundation Trust ('MUNFT') for negligent delay in diagnosing and treating a 12-year-old boy's intercranial (brain) infection.
The boy, who prior to the incident was in good health, performing well at school and a talented sports player, reported feeling dizzy and unwell with symptoms initially suspected to be related to a blow to the head from a football.
Two days later, when the symptoms persisted, the boy's GP referred him immediately to Accident and Emergency by ambulance.
A CT scan performed at the hospital showed no intercranial abnormality but swelling of soft tissue around the left eye and opacification in the frontal and ethmoidal sinuses. The boy was discharged with a diagnosis of concussion.
The following day, the boy's condition persisted and he began to vomit and feel lethargic. A further call was made to his GP who advised he should attend local A&E. Subsequently he was admitted the same day to the Childrens Observation and Assessment Unit at North Manchester General Hospital, now under the auspices of MUNFT.
At this time the boy had swelling to the left eye, altered behaviour, pyrexia ( a raised temperature), headache and vomiting. Presentation of those symptoms alone would of a suggested a possibility of sinusitis-related orbital cellulitis (an infection surrounding the back of the eye) which should have been investigated further.
Blood tests confirmed serious signs of an infection, including elevated CRP and White Blood Cells. Ceftriaxone was administered intravenously.
Once admitted to MUNFT, the boy was assessed by a locum Registrar who recommended continued treatment with IV antibiotics, urine dips and fluid. An Intracranial infection should have been suspected and an urgent consultation and specialist review by paediatric ENT (ear, nose and throat consultant) or by ophthalmology should have been conducted. Instead, he remained in hospital without the cause of his symptoms being diagnosed.
Unfortunately, the boy's condition deteriorated in the following days. He was noted to be confused, responding to commands but no longer talking. By this time, he had frontal inflammation of the brain. Enhanced CT scanning was then carried out (at the insistence of the boy's family), which established a subdural empyema (infection in the brain) He was transferred to Manchester Children's Hospital where he underwent several surgeries to drain the abscesses which had formed in his brain.
Although he has made good physical recovery, he now has persistent neurocognitive/behaviour disability and has developed epilepsy. He has been unable to continue in school and may not be able to achieve independence.
It was alleged that with proper treatment, the infection would have been successfully treated before the brain abscess requiring surgical intervention had developed and he would have avoided any permanent brain damage.
MUNFT admitted that the delay in diagnosis and treatment made a material contribution to the boy's injuries, and that medical science is unable to establish whether the boy's injuries would have occurred if it wasn’t for this delay.
The trust has now finally admitted full liability and has consented to Judgment being entered against them; the claim will proceed to calculate damages.
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For further information about delayed diagnosis claims and medical negligence claims, please call Claire Horton on 0330 460 6748 or email Claire.Horton@fieldfisher.com.
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