Child in hospital they want to discharge her but I feel uncomfortable

[Scaredmumsickchild]

7 year old tested positive for
covid last Wednesday, has been really unwell since then with high temp, sore throat and general unwellness

Admitted to hospital last night with non blanching rash and given first dose of antibiotic for meningitis intramuscular

Loads of attempts to get blood it was barbaric and eventually managed it in the early hours lt was so upsetting and she was in agony and terrified

Most bloods back ok but cultures will take up to 48 hours

They are encouraging me to take her home whilst we wait, but that will mean her having to be recanulated if we have to come back

in the mean time she’s spiking 39 temp again, so poorly and not eaten more than tiny amounts in a week and only having sips of fluids. She vomited again overnight also

Aibu to want to stay? I feel uncomfortable taking her home this unwell but they are saying they are convinced it’s only viral (Covid) and haven’t even checked the rash today! (It has faded but still not blanching)

Have they checked for sepsis? I would say trust your gut, we got sent home 3 times with DD2, they kept saying virus, 4th time I refused to leave until they did some tests. She had double pneumonia and had to be admitted for a whole week

Reading this story made me physically sick.

how horrible, how desperate, how horrifying. I’m so angry for this little girl and the ordeal she and her family had to suffer.

OP, the reality is trust your gut and if your gut is saying you shouldn’t go home, then dont.

Reading some of the horrible stories, I know one thing, I’d much rather be the over-worried mother than one that trusted doctors.

I lived my life trusting doctors and was failed, and other BERY close people in my household were too. I trust no ONE.
Medical degree or not.

Google everything.

@missmydad76 oh do shut up, they have already done a "sepsis test" by running all the bloods they have already. Fear mongering out of a personal experience is a horrible thing to do.

Really CBA to fight with people on here particularly those throwing personal insults. There are various tests doctors do to ascertain whether or not a patient has sepsis
Which they've done 🙄
Ignorance and fear mongering. What a combo.

Yes, there are various tests that look at sepsis. Which it's clear has been done - she's even mentioned a CRP result. Asking for 'a sepsis test' like you'd just tick 'sepsis' on the blood form, makes you look like an idiot who doesn't know anything.

The fighting on this thread is shameful. Can we at least remember there is a sick little girl and a worried mum? Hope everything goes well OP

There are some very unpleasant responses here which are ridiculing those with opposing views.
There are clear guidelines on how to manage possible sepsis or cases on petechial rashes. Blood cultures are not always definitive even if negative and treatment should continue in case.

I don't think that's correct can you link to these guidelines?

It's not an opposing view if its complete rubbishbsucked from a hysterical Google search. That is a lot of what is wrong with society. Just because you can Google something doesn't mean you are an expert or have a valid "opinion"

But is it @memorial . Do you know this or is it your assumption? I’d love to find out more about where treating a symptomatic patient with a petechial rash with one single dose of antimicrobials and no blood culture results is appropriate…please do let the Google hysterical know

Oh I'm sorry you misunderstood it wasn't a question. I'm a doctor. Of course you don't continue to treat "just in case ". Once the tests show it is not sepsis you stop treatment. I will link you the guidance when I am finished work. In the meantime you find me the proper evidence to say otherwise. Not daily mail hysteria.

This is a parent who is concerned about their child and having to go through significant anxiety. The child is symptomatic, has a raised CRP, where the parents is concerned, the child has no blood culture results to guide diagnosis yet and has had a single dose of antibiotics. Please do not dismiss the parents for asking if they should question the decision. I look forward to the guidelines

To be fair, I don’t think @memorial is dismissing the OP at all, or any of her posts. I think she’s referring to the posters who are spreading misinformation, and have no medical knowledge and are giving completely incorrect advice. It’s not helpful and will only potentially cause anxiety for the OP.

@Sleepingmole

We're talking about a child with a very slightly raised CRP (30 as opposed to 200+), largely normal obs other than expected tachycardia (otherwise they would have been mentioned), normal lactate levels (again, it would have been mentioned) and a petechial rash that is fading. The blood cultures will almost certainly be normal.
Yes, she's unwell but that doesn't mean she needs to be in hospital. The sepsis 6 were carried out like they should have been and sepsis has been ruled out. If she had sepsis it would show in the crp/lactate/obs.

Jennifer, this response is far more balanced and more
considerate of those questioning if this the right response than memorial.
I don’t feel comfortable making this discussion more of a fight so this is the last post. I don’t believe the mother or those questioning if the child was ready to leave were unreasonable. The responses were deeply unpleasant.
Crp raised, one dose abx and no ongoing treatment planned, non blanching rash, symptomatic. I don’t think it’s quite such a clear cut case for posters to jeer at. Very unpleasant response.
op, I hope all is going well. I know how frightening it can be as my daughter developed sepsis and the wait was awful. Love to you

@Sleepingmole

NICE guidelines

Because of the non-blanching rash of skin, she will have been considered high risk. Here are the relevant bits for you:

For children aged 5 to 11 years who have suspected sepsis and 1 or more high risk criteria:

• arrange for immediate review by the senior clinical decision maker to assess the child and think about alternative diagnoses to sepsis
• A 'senior clinical decision maker' for children aged 5 to 11 years is a paediatric or emergency care doctor of grade ST4 or above or equivalent.
• carry out a venous blood test for the following:
• blood gas, including glucose and lactate measurement
• blood culture
• full blood count
• C-reactive protein
• urea and electrolytes
• creatinine
• a clotting screen
• give a broad-spectrum antimicrobial (see section 1.7) at the maximum recommended dose without delay (within 1 hour of identifying that they meet any high risk criteria in an acute hospital setting)
• discuss with a consultant.

Other than that one initial dose of antibiotics when presenting with high risk symptoms, further antibiotics are not given "just in case". Currently, she does not meet the criteria for requiring antibiotic treatment. A CRP of 30 would not be unexpected in a person with a viral infection, nor is a raised heart rate and temp. There is nothing in her bloods to indicate sepsis, meningitis, or anything other than a viral illness. Hence, her diagnosis is Covid.

If her lactate levels were raised, she would have been given IV fluids, but OP says her bloods were fine and did not mention fluids. She can correct me if that is wrong.

Therefore,

For children aged 5 to 11 years with suspected sepsis who meet 2 or more moderate to high risk criteria, have lactate of less than 2 mmol/litre, and in whom a definitive condition or infection can be identified and treated:

• manage the definitive condition, and
• if appropriate, discharge with information depending on setting (see recommendations 1.11.5 and 1.11.6).

If her blood cultures come back positive for growth, the appropriate antibiotics will be prescribed then. She does not need to wait in hospital to get that result. She does not require antibiotics while waiting for that result.

Rashes, even non-blanching ones, are very common with viral illnesses.

I’m very confused as most guidelines I read don’t support this. One example, https://www.bsuh.nhs.uk/library/wp-content/uploads/sites/8/2020/06/Paediatric-Guidelines-Petechiae-and-Purpura-2015-1.pdf. The above poster provided guidance but it requires a definitive diagnosis for discharge which isn’t the case here? Also did I miss the sepsis screen which I guess is a targeted pcr? I am at a loss with the provided guidelines but above all, I hope op and her child are doing well. I hope their concerns were listened to respectfully

That does support it, actually. My link to the NICE guidelines is in regard to sepsis screening. Her definitive diagnosis is Covid. A viral infection. She was given one dose of antibiotics as per the NICE guidelines.

Re: your link. Basically an unwell child is a child who is very obviously seriously ill and needing urgent treatment - impaired consciousness, cold extremities, breathing difficulties. That kind of thing. That is not the case here.
You need to follow the route for "well". I.e well>bloods & cultures>normal bloods>observe>send home. A CRP of 30, in a person with Covid, is unlikely to be considered "raised" when considering bacterial meningitis.

Observe for ≥ 4 hours or admit for observation > 8 hours (particularly if pre-treated with antibiotics)

Home with safety-net advice if:

Remains well - she hasn't deteriorated
Afebrile - not having seizures
Rash has not spread - rash has faded
No Clinician / parent concern - medics are not concerned

This is where we are at.

So if all bloods are normal- they will be working with the diagnosis it's viral- most likely covid related. Blood cultures will be negative if there isnt a bacterial cause. Bloods have also ruled out meningitis. I understand she's still unwell, and that you're worried, but if IV medication isn't required, she may do better in her own environment and bed.

From my understanding the covid is a possible not definitive diagnosis.
The bloods are not normal- her CRP is raised and could go higher. it is not yet (and may not be) know if it’s viral and not bacterial.
she is still febrile, vomiting and no mention of improving bar rash improving
The blood cultures have not returned

i don’t see how this is a cut and dry ‘go home, you’re fine, don’t even question it’. Her concerns are totally valid.

OP, ignore the arguments on here.
How is your daughter this morning?

Blimey what a thread. Hope your daughter is feeling better OP.

Hi all, thank you for the support and advice.

We went home when they advised, and she’s definitely on the mend. Still off school feeling unwell but her temperature is ok now and the rash has gone.

Still not heard back re the cultures, so I’m presuming they were all ok

In hindsight it was the correct decision, but I was so worried and this clouded my judgement at the time

Have you asked them to check for glandular fever? DS was in and out of hospital and treated for meningitis pretty aggressively as was so poorly until they realised was GF.