Decision Report 201305398

Summary

Mr C complained on behalf of his daughter (Mrs A) who injured her head and neck in a sporting incident. Mrs A was taken to A&E at Forth Valley Royal Hospital and admitted to the orthopaedic ward. X-rays were taken of her neck and finger, and an MRI scan (magnetic resonance imaging scan, used to diagnose health conditions that affect organs, tissue and bone) was taken of her neck. Medical staff did not consider she had a significant head injury and she was discharged after three days. Mrs A continued to suffer symptoms from her accident and was referred to a specialist a few months later. A head MRI was taken which showed she had suffered a head injury and she was referred to the neurology department. Mrs A was diagnosed with post-concussion syndrome. Mr C complained about the delay to Mrs A's diagnosis and expressed his concern that this may have affected her recovery.

We were critical of a number of aspects of Mrs A's care. We took independent medical advice from three advisers (a consultant in orthopaedic and trauma surgery; an emergency medicine consultant; and a nurse). We found that Mrs A's symptoms should have prompted a CT scan (computerised tomography scan, which uses x-rays and a computer to create detailed images of the inside of the body) of her head in line with national guidance. We also found that Mrs A's condition was not monitored adequately in A&E, nor were her neurological symptoms adequately monitored in the orthopaedic ward. We were critical of a lack of record-keeping, which prevented us from commenting in detail with regard to a number of points Mr C had raised.

Recommendations

We recommended that the board:

• provide evidence of action taken in response to Mr C's complaint;
• issue a written apology to Mrs A for the failings our investigation found; and
• take steps to increase staff awareness of SIGN 110 (guidelines for the early management of patients with a head injury, written by Scottish Intercollegiate Guidelines Network), including the requirement for regular neurological monitoring and the indications for CT scans.