Summary
Mrs C complained about the care and treatment given to her young son (Master A) when he attended a hospital Emergency Department (ED) over a period of two days after he suffered a head injury at nursery. Master A has hydrocephalus and had had a shunt fitted a few months after he was born to relieve the pressure caused by fluid accumulation. Because of this, Mrs C said that as well as the usual checks and examination, he should also have been given a precautionary CT scan. He was not and was discharged home.
A month later, Master A and his family went abroad on holiday and he became very ill and was taken to hospital. A CT scan taken there showed that his shunt had become dislodged and he had suffered a bleed. He remained in hospital for four days before being returned home.
Mrs A complained to the board who took the view that the care and treatment given to Master A on the two occasions he attended the ED was reasonable. Our investigation showed that Master A's examination in the ED had been good, specific and relevant. However, as he had attended again for the same problem within a short time, caution needed to be taken; on the second occasion his head injury should have been discussed with a senior member of staff and as there was reason to question a shunt malfunction, staff should have had a low threshold of suspicion and considered a CT head scan. Alternatively, as his parents felt that Master A's condition had not returned to normal, he should at least have been admitted for observation. For these reasons, we upheld the complaint.
Redress and recommendations
The Ombudsman recommends that the Board:
- make Mrs C a formal apology recognising the identified shortcomings identified in this report; and
- ensure that the clinical staff involved in Master A's case make themselves fully aware of the relevant Scottish Intercollegiate Guidelines Network guidance ('Early management of children with a head injury', May 2009) to ensure that the same situation does not recur.