It comes with great regret that I write about another case of clinical misdiagnosis, this time one that left a toddler with his legs and seven of his fingers needing amputation.
I previously wrote about the importance of diagnosing sepsis "as urgently as a heart attack", it really is a killer if left undiagnosed. Today I came to read the story of little Reuben, who was rushed into hospital after he accidently burned himself.
After being seen only two days earlier, Reuben was rushed back into hospital with what doctors misdiagnosed as tonsillitis. Within 24 short hours Reuben was fighting for his life as toxic shock syndrome attacked his body. The doctors had misdiagnosed Reuben's symptoms as fever and a sore throat.
In those short 24 hours, deadly bacteria had infected the wound his burn had left and was pumping poisonous toxins around his body. There was nothing the doctors could do in time to save Reuben's legs; amputation was the only way they could save his life.
Reuben's mother was reported to have said:
"At one point I thought we were going to lose him. The consultant had tears in her eyes when she told me he would have to undergo an amputation. I'm speaking out because I want to raise awareness of toxic shock and sepsis. More needs to be done so that the medical profession recognise the link between burns injuries and toxic shock."
"At one point I thought we were going to lose him. The consultant had tears in her eyes when she told me he would have to undergo an amputation. I'm speaking out because I want to raise awareness of toxic shock and sepsis. More needs to be done so that the medical profession recognise the link between burns injuries and toxic shock."
Dr Nelly Ninis of the Imperial College Healthcare NHS Trust went on to say:
"It is very serious indeed because you are effectively racing against these toxins and it's a race against time.
"It's absolutely vital that sepsis, or toxic shock syndrome, is correctly diagnosed and quickly. If you are dealing with a small child who is non-verbal, it's important to listen to the parents' worries."
"It is very serious indeed because you are effectively racing against these toxins and it's a race against time.
"It's absolutely vital that sepsis, or toxic shock syndrome, is correctly diagnosed and quickly. If you are dealing with a small child who is non-verbal, it's important to listen to the parents' worries."
Like many of my own clients, Reuben now gets around his home with the help of prosthetic limbs, something which he will need for the rest of his life.
It was reported that Ipswich Hospital NHS Trust has admitted complete liability and offered an unreserved apology to Reuben and his family.
I've always considered an apology a good start, but not an acceptable end. Through litigation, Reuben has ensured that his future care needs, prosthetics and other specialist requirements will be funded and that he will receive the appropriate compensation he needs, to try and improve his quality of life moving forward.
Lessons must be learnt. This is not the first time and unfortunately it probably will not be the last that such a misdiagnosis leads to such devastating consequences.
Ipswich Hospital NHS Trust was reported to have said:
"We are now working with the family to ensure that lessons are learnt from Reuben's case and further training has been provided to A&E staff on recognising the warning signs of septic shock treatment."
"We are now working with the family to ensure that lessons are learnt from Reuben's case and further training has been provided to A&E staff on recognising the warning signs of septic shock treatment."
I hope that for the sake of other children and adults alike, this is the case, and that clinicians take away an important lesson from Reuben's story; that sepsis and toxic shock are medical emergencies and need to be diagnosed and treated immediately.
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