I suspect sepsis - have I been fobbed off?

[teamaven]

I called an ambulance for my 5 year old daughter this morning (who is never ill and I’ve never phoned an ambulance so to me it was serious). She woke up at 1:30am screaming and crying that her lower left side hurt. She said she couldn’t move and wouldn’t settle all night despite us thinking she’ll be fine and trying to go back to sleep - then started complaining of a headache at the back of her head and her temp went up to 39.9.

She was extremely hot to the touch, a bit confused and lethargic so I panicked and called an ambulance. After an hour of Neurofen her temp went down to 38.4 and stayed like that for a couple of hours.

I suspected a urine infection (possibly that had developed into sepsis!) because she has had one before and her pull up (she’s still in them at night) was so heavy and absolutely reeked. Her urine test showed signs of infection so the doctor agreed it was probably an infection that had travelled up.

Now, I did ask him to do a blood test anyhow and he said it wouldn’t show anything, but would it not show how bad the infection is ie sepsis? He sent us home with 10 days oral antibiotics and daughter is asleep now but I’m scared that based on her symptoms it was much worse than just a urine infection? The very high temp, lethargy, confusion, headache?

Can anyone provide what the usual pathway is when a child comes in with those symptoms? I feel like we shouldn’t have been sent home - at least to be observed over a few hours?

Lots of people with sepsis don’t die but it causes long term damage to their health anyway. I’m not even talking about limb amputations. My father had significant heart damage post sepsis and had to have 2 valves replaced and was disabled as a result

Not for everyone.

Just because it happened to your father doesn't mean it happens to everyone.

A&E are very happy to re-examine children because they change so fast. If you’re worried, you can go back.

I agree, it’s just the UK with bizarre attitude towards blood tests as not informative. In my home country the approach is the same and blood tests is the first step in any illness

Hope your little one is ok

Yes, but let’s not pretend just because someone didn’t die of sepsis they will be definitely okay. They can be or they can havd long term consequences

That isn't what I said.

Don't twist my words.

Blood tests do inform.
So does the clinical picture.

https://www.england.nhs.uk/patient-safety/marthas-rule/

I just wanted to highlight Martha’s Rule, OP, in case you haven’t heard of it. I’m sure your daughter has a nasty infection and will get better in time, but it’s worth knowing about if you do have to take her back to A&E.

I wish that was true.

My nephew had appendicitis at five years old and was sent home multiple times with antibiotics for a UTI. He was so ill and the local hospitals weren't helping that my sister put him in the car and drove him up to the RVI at Newcastle where he was operated on immediately because his appendix had ruptured. He spent three weeks on multiple antibiotics and was extremely ill.

Doctors can miss things.

@teamaven please trust your gut and seek a second opinion if you think it's needed. I'd ask about appendicitis too because it can present differently in young kids.

Call 111 and if you’re concerned go to A&E

I think its perhaps the blood test system is more of a hassle there, they don't have the POC quick tests (or at least they don't have widespread use of them). Here all the doctors have them, also at least in my health centre can get proper blood tests done the same day if needed, the lab is in the same building and results come back quickly, most come back the same day. And even when the lab is closed the nurses can do certain blood tests right there with results before you go home. But of course blood tests just form one part of the picture, but its a very helpful part.

I hope she's ok OP - if you're worried I would take her back, it's not worth the risk. Sepsis has been missed many times unfortunately too many sad stories of people that haven't survived. Trust your instincts. Better safe than sorry.

People misunderstand sepsis and think that it means bad infection. A minor infection can lead to sepsis and a very serious infection can be just an infection with no sepsis. Sepsis is an overwhelming overreaction to an infection.

@teamaven I'm sure that they did basic observations on your DD? Her overall condition will be a much bigger indicator than her blood results.

mayba she mixing up cystic from sepsis

My son was admitted to hospital with suspected urinary sepsis at the beginning of the year.

His symptoms were urinary retention, BP dropped to unreadable and he had a seizure and HR very fast. He then lost consciousness when the paramedics say him up.

He had a blood test which showed his CRP was 110 which indicated sepsis level but fluids meant he did urinate and tests showed no infection in his urine. Head ct and chest x ray were also clear.

so yes, a blood test can show infection but not what it is or the source and sepsis isn’t diagnosed by a blood test alone.

A raised CRP can indicate an infection.

Which would be expected with someone who presented with signs and symptoms of an infection.

There is no magic number, or test, that indicates sepsis.

No but we were told his CRP level alongside his other symptoms indicated a risk it being sepsis. They said it was high. I would have no idea what it meant not being a Dr!

I only know what I know because ds consultant explained it all to us.

Risk of it being sepsis.

You can be really unwell with an infection and it not be sepsis.

If you have an infection your inflammatory markers will be high.

I’ve known people with CRP of 300-400 who had a nasty infection but not sepsis. As said above, you’re unlikely to have sepsis with a normal CRP, but a raised CRP doesn’t necessarily mean sepsis.

Context is important. DH was ill and saw a nurse practitioner who wanted to send him home with oral antibiotics and an inhaler. I knew he was very ill (partly because he'd agreed to have an appointment). She was reassured that his heart rate was 'only' 100. I was not reassured because I know his resting heart rate is usually 50. We got to A&E and the triage nurse muttered 'some infective process?' when his fingers were yellow and they couldn't get a sats reading. He had a severe pneumonia (CRP 631) and once they got the results and the chest x-ray they whipped him out of the waiting area onto a trolley until a ward bed was available. Similarly, if my heart rate was 110, I'd not be too worried because I know that I run at about 100 on a good day.

Hi Op,

A&E sister here- sorry your little one is so poorly.

Typically the initial observations (blood pressure, pulse, temp etc.) are used to create a PEWS score which is a number indicating how unwell a child is. There are also specific PEWS markers that trigger the sepsis pathway and sepsis red flags also that the hospital use as a pretty accurate indicator of whether sepsis is present.

It would be very unusual (although not impossible) for a child to have a normal PEWS/ no sepsis indicators, but still be septic. I assume in your lo case all observations therefore did not point to sepsis.

Blood tests can give indications on the severity of an infection (CRP, WCC etc.) We also use Procalcitonin blood tests which are a strong marker for identifying sepsis/ severe bacterial infections necessitating inpatient stay and sepsis treatment, so they could have done this if it was suspected.

In any case, trust your gut, if you’re worried please return to A&E, you won’t be the first or the last mum to do so, and often proves lifesaving in the case of deteriorating children that have been missed.

Please use “Martha’s Law” it is a nationwide initiative that requires hospitals MUST allow parents/ relatives to request a second opinion by a senior clinician or the clinical outreach team or equivalent (they assess and treat very sick patients within the hospital). It is an incredible incredible initiative now in place.

Good luck op, sending love xx

Yes this was pretty much explained to us.

DS is an athlete. He is fit.

His BP dropped 70m something when the paramedics sat him up.
6 minutes after he collapsed and had a seizure at home I tried to get his BP using my machine and it kept saying error so they deduced it was because it was so low at that point too.

He didn’t urinate for 20 hours

he was absolutely freezing in himself. Full on tracksuit, blanket, hat on head inside an and e and shivering with all muscles spasming whist having a temp of 40° and like a furnace to touch with a bright red face.

the blood test was only part of the story. We never did get an ending to the rest.

All we got results wise from tests is that they compared his CT to his previous MRI and his arachnoid cyst hadn’t changed.

He does have a neuromuscular condition so they are wondering if it was a severe inflammatory response to a simple virus (his condition is similar to MS which can produce these reactions).

Wasn’t great timing as he missed commonwealth trials due to being in hospital but amazingly he made British champs 7 weeks later!

I set osces for sepsis at university level and I’d only expect bloods and blood cultures to be done if someone’s NEWS score indicated it necessary. A temp and a headache wouldn’t be enough.

You need to give the antibiotics time to work and of course make sure she is drinking enough. Doctors use a scoring system for sepsis now and presumably that was done in A&E. I’m sure she will recover quickly but will be followed up if it happens again.