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Bristol Children's Hospital missed diagnosis.


DOCTORS "failed" a toddler by not diagnosing a brain tumour that later killed him, an inquest has said.

Ayaan Hussain died at Bristol Children's Hospital on December 11 2014. The toddler, who was 23 months old, had been rushed to hospital after suffering a fit and respiratory arrest.

At an inquest into his death in Avon Coroners' Court, senior Avon coroner, Maria Voisin, said she considered it a "failure" of the University Hospitals Bristol NHS Foundation Trust that signs of the little boy's illness were not picked up sooner.

A review carried out by the Trust found that the toddler would have had a 40 to 80 per cent chance of survival for up to five years, if his tumour had been detected earlier.

The court heard that Ayaan began vomiting most mornings from late October and also went off food and water.

Miss Kennedy took him to see a GP on November 21 before rushing him to the emergency department of Bristol Children's Hospital three days later after the toddler had lost balance and fallen in to a chair while her sister was babysitting him. The aunt thought Ayaan might have suffered a stroke.

In a statement read out in court Miss Kennedy said: "He was getting more and more unwell before my eyes. His behaviour was now erratic and he was having tantrums that he had never had before. Sometimes he would go in to fits of crying and screaming and would often seem confused. He had been getting a lot more clumsy generally."

During his visit, doctor Isabell Hancock, a registrar, who had been in the department for three months, treated Ayaan.

She spent half an hour assessing the toddler and told the court that, while she had neurological concerns due to his persistent vomiting, Ayaan's behaviour and checks were normal.

Uncertain of the precise diagnosis, she sought advice from a senior consultant who diagnosed the toddler as having problems digesting dairy. Dr Hancock said she sent a paediatrician referral to Ayaan's GP, but it was delivered to the wrong address.

Less than a week later Mrs Kennedy took Ayaan first to Broadmead Medical Centre and then the emergency department on November 30 after the toddler had been vomiting for several days, holding his ear and arching his back.

On that visit she saw consultant paediatrician doctor Nicholas Sargant. She said: "Dr Sargant seemed agitated and uninterested once Ayaan failed to cooperate. I believe he didn't listen carefully to all my concerns which I felt led to the misdiagnosis.

"I begged him to undertake some checks on my son. Dr Sargant replied - and I will never forget his words – ‘I cannot possibly arrange a test for every poorly child which comes through this waiting room’."

When giving his evidence Dr Sargant said Ayaan was tired and irritable when he saw him and as a result he couldn't complete all the checks – including one to observe the back of his eyes - but that it appeared that the toddler was suffering a stomach complaint perhaps caused by lactose intolerance.

He added: "Whilst we are all devastated that we missed Ayaan's tumour and missed an opportunity probably to save his life – although not certainly – it is a very rare diagnosis.

"What I am most disappointed about is, in terms of seniority, I was the most senior person to have seen Ayaan prior to him presenting in his final admission and this is very hard to live with.

"I have never had anything like this happen to me before and, if the story had been presented to me as I have heard it today, I have no doubt I would have ordered a scan."

Dr Sargant also said he wished he had asked the mother to bring Ayaan back the following day to the hospital for a check-up.

Mrs Kennedy took her son to see doctor Maytum at Broadmead Medical Centre on December 2, and after that visit Ayaan became increasingly unwell and started vomiting hourly.

On the morning of December 10 he had a fit and was rushed to hospital after suffering respiratory arrest.

Miss Kennedy said: "It was terrifying. His little body was rigid. I could tell his heart was racing. I held him against me and I didn't know what to do. I had been forced to nurse my own son in the final days of his life without any medical help."

After a scan doctors discovered that the toddler had a brain tumour and he underwent an emergency operation which was unsuccessful and Miss Kennedy was told there was nothing more they could do.

Ms Voisin delivered a narrative conclusion to the inquest saying she considered the second emergency department visit as a "missed opportunity" to diagnose the tumour and that she "considers this to be a failure."

She added that "on the balance of probability" diagnosis on the visit "would have resulted in treatment which would have prolonged his life." The cause of death was given as obstructive hydrocephalus – swelling on the brain.