Errors and Delay in Diagnosis

Delay in Diagnosing Appendicitis

Appendicitis is a very common ailment yet every year people suffer from the awful consequences of a failure or delay in diagnosis at the appropriate time.

In women, the delay and subsequent perforation of the appendix can lead to infertility.

The delay may lead to peritonitis and blood poisoning (septicaemia). This can also cause kidney failure and multi-system failure. If this happens the patient may require a period of time in the Intensive Care Unit, kidney dialysis and even need the assistance of a life support machine.

Other side-effects may be the requirement of a temporary stoma (colostomy or iliostomy). This is where the bowel is brought through the abdomen and the patient can then pass stools into a bag. This allows the damaged bag to be rested for a period of time before the stoma is closed.

Unfortunately sometimes the stoma may be permanent.

Delay in Diagnosing Diabetes

There are two types of diabetics, Type I and Type II. Ususally Type I is controlled by insulin injections and Type II is controlled by diet and tablets.

It is important to diagnose diabetes as soon as possible as too much sugar in the blood can cause a variety of problems and cause long-term damage to the eyes and kidneys (amongst other things). Therefore it is imperative to diagnose this as soon as possible and to implement appropriate teratment.

Often a diagnosis is only made when a patient is complaining of one or other of the side effects of diabetes and attends their GP/A&E Department. In some cases patients can fall into a coma and require hospital admission to the Intensive Care Unit in order to be stablilised.

Even if a diagnosis is made, when someone suffering from diabetes is being treated for other conditions, some of which may be totally unrelated, consideration must be given to ensuring that blood sugar levels remain stable throughout any treatment and/or operations. If not this can have disastrous long-term consequences.

Delays in Diagnosing Meningitis

Pardoes have assisted many clients in the past in cases involving a delay in diagnosing meningitis and also cases involving inadequate treatment to prevent damage caused by meningitis following diagnosis.

There are a number of strains of meningococcus which is the bacterial pathogen responsible for meningococcal disease.  They are a common colonist of the human upper respiratory tract being the membranes lining the back of the nose and throat.  Research suggests that nearly 1 in 100 young children (between birth and the age of 4 years) carry the germ entirely asymptomatically and this figure rises to as high as 1 in 20 in the teens.  This carriage, which may last for many months, is nearly always harmless, and some experts believe may even be beneficial in leading to immunity to more serious infection.

The problems arise when the bacteria very occasionally break through into the blood stream from their colonising site and this can initiate an invasive infection.  Humans deploy a range of protective mechanisms to limit bacterial proliferation in the blood stream, even in the absence of immunity previously generated by natural exposure or vaccination, so that many of these episodes are terminated spontaneously without there ever being signs of any serious illness.

However, the meningococcus has a greater ability than many other bacteria to defeat host defences and to multiply to higher and higher levels in the blood stream.  When this occurs, the release of bacterial toxins can cause symptomatic illness which is often referred to as septicaemia.  This shows itself initially by various non-specific signs and symptoms of a generalised inflammatory response such as an elevated temperature, lack of interest in food, vomiting and general lethargy but as the bacteria proliferation gets worse, it can lead to dramatic symptoms and signs, often including severe limb pains and a rash of dark red/purple spots which is caused by blood leaking from damaged tiny blood vessels into the superficial layers of the skin.  These spots are usually small and non-blanching meaning that they do not fade on pressure.

There may well follow signs of secondary focal infection in areas of the body outside of the original focus of an infection such as the joint spaces and occasionally the membranes covering the lining of the brain causing meningitis.

Accompanying these clinical signs are changes found on hospital investigations including raised and often very raised c-reactive protein (CRP) in the blood, a raised white cell count and, clenching the diagnosis, meningococcal bacteria in the blood stream and in cases of meningitis, in the cerebral spinal fluid.

When meningitis actually takes hold and meningococcal bacteria evade the cerebral spinal fluid, then patients can exhibit signs such as a stiff neck, a painful aversion to light and signs of raised intercranial pressure on the brain to include severe headache, nausea, vomiting, irritability, confusion, drowsiness and seizures which can progress to a loss of consciousness and fatal conclusion in untreated cases and severe devastating damage in cases which do not lead to a fatality such as hearing loss, brain damage and orthopaedic growth plate disorders.

Early intervention and diagnosis is extremely important.  Nowadays General Practitioners and other secondary health care providers are very aware of the early clinical signs of meningitis although this bacterial infection can often be confused with a viral infection.

It is important that the primary health care provider takes a very detailed account of the history of the presenting complaint and also the presenting complaint.  If there is reason to consider that there is a potential for a bacteriological illness, to refer to hospital immediately so that the necessary tests and investigations can be undertaken and the correct treatment provided which will include a host of blood tests, sometimes a lumbar puncture to test the cerebral spinal fluid and if diagnosis is confirmed, or even if it is suspected, to commence appropriate intravenous antibiotics and to continue the course of the antibiotics for an appropriate time.  Some hospitals are not equipped to deal with meningitis cases and need to consider transfer to specialist paediatric units.

Medical Negligence Lawyers

If you or a loved one have a failure in diagnosis claim, please contact our medical negligence team on 01278 457891, email enquiries@pardoes.co.uk or complete our short enquiry form.