Oliver George Hiscutt · Prevention of Future Deaths report

On 9 October 2012 an inquest was opened into the death of Oliver George Hiscutt, aged 2 years 11 months. The inquest concluded on 19 March 2014. The medical cause of death was:
1a. Catastrophic Haemorrhage
1b. Retropharyngeal infection eroding into major artery
1c. Group A beta haemolytic streptococcal infection.

Oliver Hiscutt's death was due to natural causes.

On Friday 21st September 2012 the deceased was unwell with a suspected cold. He subsequently developed a rash and was taken to his GP on 24th September 2012, where a viral infection was diagnosed. By 26th September he had developed a stiff neck with reduced movement. There was also swelling to the neck observed by his parents. He presented to the Emergency Department at Wythenshawe Hospital where neck stiffness was noted. He was assessed and discharged with a diagnosis of viral tonsillitis. Over the next four days he did not improve with regular paracetamol. By 30th September 2013 his parents felt that he had deteriorated too much to wait for a GP appointment and again attended at the Emergency Department of Wythenshawe Hospital. He was commenced on IV antibiotics and admitted to the ward. A two day history of neck swelling and neck pain was noted. A peritonsilar abscess was queried but ENT review concluded that there was no abscess present. He showed some improvement during his admission and was changed to oral antibiotics and discharged home on 2 October 2012. On 2nd October 2012 Group A beta-haemolytic Streptococcus had been found in blood cultures and a throat swab. By 4th October 2012, he had deteriorated at home. He was eating less and appeared to be holding food in his mouth before spitting it out. On the morning of 5 October 2012 his mother discovered a large volume of vomit on his bed and pyjamas containing fresh and old blood clots. He was taken to the Emergency Department of Wythenshawe Hospital where he was readmitted and started on IV antibiotics. A swelling in the left side of the neck was identified. His clarity of speech deteriorated and he appeared to be in pain if moving his jaw. He developed an underbite and his jaw was protruding. He developed drooling and had difficulty swallowing. At approximately 6.00 am on 7 October he suddenly woke up and vomited a large amount of fresh blood from his mouth and nose. He had a cardiac arrest at which time he was resuscitated. He was transferred to theatre where the bleeding was stopped. He suffered a further cardiac arrest and, despite resuscitation, life was pronounced extinct at 9.30am. At post mortem it was discovered that the deceased had a retropharyngeal abscess which is entirely in keeping with the complications of a Group A beta-haemolytic streptococcal infection. An arterial structure with a completely necrotic wall was identified within the infected tissues, from where it is likely that the catastrophic haemorrhage originated.

Currently it is not mandatory for GPs to undertake formal paediatric / child health training. Facing the Future (2011) states that there are currently 10 000 GP trainees in the country and less than 25% of them will undertake any paediatric placement during their training. GP trainees who do undertake a paediatric placement during their training gain a range of educational benefits such as the development of skills in spotting the sick child, specialist management of children with long term conditions and multi disciplinary team working.

The Royal College of General Practitioners and the Royal College of Paediatrics and Child Health strongly support all GPs having exposure to acute paediatrics as part of their vocational training. Offering every GP trainee a hospital post in paediatrics within the current 3 year specialty training programme is undeliverable. The Royal College of General Practitioners makes the case that there should be an enhanced 4 year programme of GP training and that all GPs should undertake specialist led paediatric training. Specialist led paediatric training will ensure that future GPs have the skills and experience they need to assess and respond effectively and safely to sick children, to better co-ordinate the care of children with long term conditions and to safeguard those at risk.