Girl, 5, dies of sepsis just hours after doctors send her home with paracetamol for a ‘typical childhood illness’, inquest hears
A GIRL died of sepsis just hours after being sent home from hospital with paracetamol for a "typical childhood illness", an inquest heard yesterday.
Breathless Ava Macfarlane, 5, was rushed to A&E at Nottingham's Queen's Medical Centre with a fever, red rash, and extreme lethargy.
But she was discharged with just paracetamol and ibuprofen - with her mum told she was suffering from a "virus that's going around".
Tragic Ava's condition worsened within hours of getting home, forcing her parents to take her back to hospital on December 14, 2017.
She continued to deteriorate and despite treatment, died in the early hours of the following morning.
A jury inquest into Ava's death at Nottingham Coroner's Court heard she died of sepsis - the body's overwhelming response to infection.
TOXIC SHOCK SYNDROME
She had succumbed to the deadly condition after contracting Toxic Shock Syndrome (TSS).
TSS is a bacterial infection that releases harmful toxins into the bloodstream and can cause multi-organ failure.
It became well-known in the late 1970s and early 1980s after women contracted it by using certain brands of super-absorbent tampons.
Ava's devastated mum Lesley Gearing told the hearing her daughter, who was born with Down's Syndrome, had been poorly for around a week before her death.
But she then developed a severe rash across her body that "looked like she had a T-shirt on".
It was like we were hurting her when we were touching her
Lesley Gearing
Ava soon developed breathing difficulties and her eyes started rolling, Ms Gearing said.
She told the hearing: "It was like we were hurting her when we were touching her.
"I laid her back on the bed and she went back to sleep again.
"I gave her calpol but had to give it her like she was a baby. She couldn't hold her head up.
It was then that she and Ava's dad, Adam MacFarlane, decided to drive her to hospital at around lunchtime on Dec 13.
DIDN'T FOLLOW GUIDANCE
A nurse took a first look at Ava before she was seen by a consultant - who later admitted not following the "Sepsis 6" pathway.
The guidelines are designed to help spot and immediately treat the condition in patients.
Giving evidence on Monday, Consultant David Shearn accepted that "earlier treatment may have improved her chances of survival".
The inquest heard Dr Shearn, who had been a consultant for 15 months, had instead adopted a "watch and wait" approach.
What is sepsis, what are the signs and symptoms and how do you get it?
SEPSIS is the primary cause of death from infection around the world, claiming around 40,000 lives in the UK each year.
That's more than bowel, breast and prostate cancer combined.
The condition is always triggered by an infection.
Most often the culprit is an infection we all recognise - pneumonia, urinary infections (UTIs), skin infections, including cellulitis, and infections in the stomach, for example appendicitis.
Typically, when a person suffers a minor cut, the area surrounding the wound will become red, swollen and warm to touch.
This is evidence the body's immune system has kicked into action, releasing white blood cells to the site of the injury to kill off the bacteria causing the infection.
The white blood cells and platelets form blood clots in the tissues around the cut.
Blood vessels swell to allow more blood to flow, and they become leaky, allowing infection-fighting cells to get out of the blood and into the tissues where they are needed.
This causes inflammation, which appears to us as the red, warm swelling.
When sepsis happens, this system goes into overdrive.
The inflammation that is typically seen just around the minor cut, spreads through the body, affecting healthy tissue and organs.
The immune system - the body's defence mechanism - overreacts and the result is it attacks the body.
It can lead to organ failure and septic shock, which can prove fatal.
Bacteria, viruses, fungi and parasites can all trigger sepsis - though the most dangerous culprit is bacteria.
In developing nations, the condition remains a leading cause of death.
Known by its colloquial name "blood poisoning", sepsis is also often referred to as a "flesh-eating disease".
Sepsis is a condition that fails to discriminate - it can affect old and young, those who lead healthy lives and those who don't.
As with many life-threatening illnesses, the most vulnerable are newborns, young children and the elderly, as well as anyone with a weakened immune system.
If you, a loved one, or in the case of medical professionals their patient, feels "severely sick", doesn't appear to be themselves and shows any of the following symptoms, sepsis should be suspected:
- weakness
- loss of appetite
- fever and chills
- thirst
- difficult or rapid breathing
- rapid heart rate
- low blood pressure
- low urine output
If a person is suffering these symptoms and they are thought to have suffered an infection - pneumonia, abdominal infection, urinary infection, or a wound - sepsis is a likely cause.
He told the hearing: "I thought it was a viral illness as that is much more common than a bacterial illness.
"It was a clinical decision to observe Ava to see how the condition developed. A high volume of febrile children settle down."
When asked by coroner Laurinda Bower if he had told Ava's parents that he was going against the Sepsis 6 pathway, he said "no".
Asked why not, Dr Shearn replied: "I don't know."
He added it would have "most likely been helpful" if Ava had undergone immediate tests and treatment for suspected sepsis.
GIVEN IBUPROFEN
Ms Gearing said: "Ava was given ibuprofen and we were told they would check her again to see if her temperature had come down."
She later explained that she was told to monitor her daughter's condition and return to hospital if her illness worsened.
But Ms Gearing added she wasn't given any advice what symptoms to look out for - or warned about the possibility of sepsis.
Asked by Ms Bower what diagnosis she was given for Ava, Miss Gearing replied: "Virus. They said there was a virus going around."
She told the jury she thought she and Mr MacFarlane had been given the "best possible advice" when told to take their daughter home.
But that night Ava worsened, developing diarrhoea.
Ms Gearing said Ava's chest also became "hotter and hotter" - and her hands and feet were "freezing".
'VERY POORLY CHILD'
By next morning Ava was "crying every time" she was touched and soiling herself when she was moved, so she was rushed back to hospital.
The inquest heard the family was kept in the cubicle and told a bed was being found for Ava in the children's intensive care unit.
Ms Gearing said a female doctor eventually opened the curtain and said Ava was a "very poorly child who should be upstairs".
She added: "I heard her mention sepsis. I have heard a lot about it and my first thought was 'we've got it in time'."
Ava was moved to a bed, placed in an induced coma, and given antibiotics.
But her condition continued to deteriorate and she died in the early hours of December 15.
Ms Gearing said: "Ava decided she had had enough. Her heart just stopped."
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She claimed she only discovered her daughter's cause of death when she read it in a coroner's report.
Opening the inquest, Ms Bower said: "Doctors thought it was a typical childhood illness and she was discharged with advice given to observe her."
The hearing, which is expected to last two days, continues.
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