"Misdiagnosis - juvenile arthritis"

Daughter attended A&E at Addenrookes hospital in April 2019 unable to walk.  subsequently given and attended appointment at ‘limping child clinic’ run by orthopaedic doctor.  After xrays, and an examination by registrar only (NOT by the senior colleague) the senior doctor returned and spoke to patient and her parent to tell us that there was a clear diagnosis, of Osgood-Schlatter disease, which is not serious and is likely to go away over time,  At no point did the main doctor actually do any thorough muskoskeletal examination e.g., based of PGAL protocol. If they had done they would have seen that even at this point the patient had very restrictive moment in her wrists. I.e. the patient was not thoroughly examined. 

When the parent /carer asked about what other possible diagnosis might be relevant, and whether they were totally confident it was Osgood-Schlatter, the doctor was dismissive in the extreme of the question, and completely ignored the carer. At no point was there any discussion about the possibility of a differential diagnosis of Juvenile Idiopathic Arthritis.

Over the next eight months the child lived with increasing levels of extreme pain including her hands, wrists, shoulders, foot, in addition to her knees. Over these many months she was frequently in much pain and completely unable to walk. At no point in any of her follow up appointments did her doctor examine the child, or raise the possibility that the diagnosis could be wrong.

In December, the physio associated with the child’s care correctly recognised that the child’s diagnosis was most likely incorrect, and contacted the gp to ask for a referral to be made to the rheumatology team. In January 2019, 10 months after her initial presentation at A&E the child was seem by the paediatric rheumatology team and an immediate and correct diagnosis of Juvenile Idiopathic Arthristis was made and treatment started immediately.

I would like this case to be raised with Addenbrookes Hospital and specifically the clinical lead for the Limping Child Clinic, and the Governor of the Trust responsible for patient experience.  I would explicitly invite an explanation from the doctor who failed to correctly diagnose the presence of a serious auto-immune conditioning where early diagnosis is predictive of better long term outcomes.  My child lived for 10 months is an awful lot of pain. This was avoidable if her doctor had simply done their job and done a thorough clinical exam (left this to the registrar) and if then, and at follow up appointments appropriate clinical care (e.g. musculoskeletal exam such as PGAL) had been done to identify if was not just a problem with the patients’ knees.

As a result of this doctor’s incorrect diagnosis, and subsequent failure of care to correct the incorrect diagnosis at follow up appointments, a ten year old lived in daily pain, often extreme pain,  for 10 months with no appropriated treatment.  By the time her correct diagnosis was made in Jan 2019 she could not walk, dress herself, or eat properly.  Poor quality care in the limping child clinic, and the doctor's lack of interest  in thorough clinical examination, and dismissal of Carers questions, lead directly and causally to suffering and unnecessary pain for a child.

 

I believe this should never have happened to my child, and should not happen to another child.  The misdiagnosis, and opportunities to subsequently correct this misdiagnosis constitute unacceptably poor quality care.