A previously healthy four-year-old Leicester boy died from a bacterial infection just three days after developing a cough, an inquest heard....
A previously healthy four-year-old Leicester boy died from a bacterial infection just three days after developing a cough, an inquest heard.
Samar Raj Singh was taken to hospital three times in two days before he died on December 12, 2022, during a national outbreak of Strep A that killed at least 16 children.
The inquest into his death heard how Samar 'was a child who filled every room with his smile' and had a 'vibrant, cheeky personality that brought joy, laughter and warmth to everyone around him.'
The four-year-old was a pupil at Wakerley Primary School and the beloved child of Parminder Singh and Gurmanjot Kaur.
Samar had never been unwell before, the inquest heard.
His parents had decided to keep him off school on Friday, December 9, 2022, as Samar had developed a cough.
But over the following days, his temperature reached 40 degrees and he suffered from stomach pain and vomiting.
His parents then took him to the children's emergency department at Leicester Royal Infirmary two days later, on Sunday, December 11.
The inquest heard how he was assessed and diagnosed with an upper respiratory tract infection and discharged home with safety advice.
The family returned, however, to the hospital that evening as Samar remained unwell and with a high temperature.
Samar's mother expressed concerns about scarlet fever and Strep A infection, but at that time there were no physiological signs that indicated this, the inquest was told.
It also heard how the hospital was extremely busy that night and the family were told that the waiting time to be seen by a doctor had escalated to ten and a half hours. Samar was taken home at 10.53pm.
The next morning, on December 12, Samar's condition worsened and his rash became pronounced and felt like sandpaper.
His mother tried multiple times to get through to the GP surgery, but as the surgery's receptionists do not start answering the phone until 8am, she eventually went to the surgery in person and showed photographs of Samar's rash to the receptionist.
When a nurse saw Samar at 11.15am, she was 'immediately concerned' and called another doctor who suspected sepsis and called 999 for an urgent ambulance.
The ambulance service was, however, experiencing a very busy period and categorised Samar as a Category 2 case with a four-hour wait, the inquest was told.
The call was later escalated to more urgent, but by that time Samar's parents had decided to drive him to hospital themselves on the urging of the doctor.
Once they arrived, Samar was quickly assessed and moved to a high dependency bay within the emergency department and within 13 minutes was assessed by a children's registrar.
A chest X-ray showed abnormalities in the right and middle lobes of the lung, along with a large collection of fluid on the right side of the chest.
The inquest heard that this was diagnosed as empyema.
While referrals were being made to obtain a paediatric surgeon to drain the fluid, Samar collapsed and cardiac resuscitation was started.
Seventeen clinicians worked on Samar to try and resuscitate him for 45 minutes but he could not be saved, the coroner was told.
It was accepted that there was a mistake during the resuscitation in that drugs were calculated for a weight of 18kg when Samar had been weighed earlier at 26kg, the inquest heard.
However, the doctors who treated him and Dr Fitzsimmons, an independent expert witness, said this had no effect on the outcome as Samar had been given so many drugs to try and resuscitate him that this was not relevant.
Samar was pronounced dead at 3.55pm on Monday, December 12, 2022, at Leicester Royal Infirmary.
Dr Fitzsimmons concluded there were no breaches of duty in the standard of care provided to Samar on his two admissions on Sunday, December 11 and none on his admission on December 12.
The inquest heard that Samar's FeverPAIN score was 2 at his first hospital attendance, and the threshold for giving antibiotics had been lowered to 3 during the increase in Strep A infections, the coroner was told.
Antibiotics were not indicated at his earlier hospital attendances based on this score and his clinical presentation and even if antibiotics had been given on the morning of December 12, they would not have been in his system long enough to affect the outcome, the inquest heard.
A jury at the inquest, held between Monday September 29 and Thursday October 2, officially concluded that Samar died from natural causes with the cause of death recorded as 'sepsis due to invasive group A streptococcal infection'.
According to the NHS, sepsis occurs when your immune system overreacts to an infection, and it can damage the body's tissues and impair blood flow.
Symptoms of sepsis in a baby or young child can include blue, grey, pale or blotchy skin, difficulty breathing or being sleepier than normal.
Strep A infections are more common in children, but adults can also sometimes get them.
Most Strep A infections are not serious and can be treated with antibiotics, but the infection can rarely cause serious problems, which is called invasive group A strep.
There were 22 cases of scarlet fever in Leicestershire in the first week of December 2022, with cases nationally 20 times higher than two years previously.
At least 16 children nationally died from invasive Strep A that year.
The NHS advises that while it can be difficult to tell when a child is seriously ill, the main thing is to trust your instincts.
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