A little boy who died hours after being discharged from hospital had "looked well" during his A&E consultation, an inquest has heard.
Adam Soeb Bapu was rushed to Royal Bolton Hospital at around 9.30pm on April 1 - his seventh birthday - as he was “struggling to breathe” and felt lethargic, Bolton Coroner’s Court was told. He had also been vomiting and suffered from a “slight cough” in the week before.
After being triaged, he was seen by emergency clinician Dr Shanmugam on the Accident and Emergency ward. Dr Shanmugam told the court that Adam’s vital signs were all normal and that he discovered no laboured breathing or other causes for concern such as tracheal tug.
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He added that Adam "looked well" and diagnosed him with a viral respiratory tract infection. Due to Adam’s presentation, Dr Shanmugam discharged him and recommended a Beconase nasal spray to help alleviate his symptoms.
After returning to his family home in the Halliwell area of Bolton, Adam’s mum Tosifa Bapu noted that his breathing was “noisy”. As she was concerned about him, she decided to let Adam sleep in her king size bed with her that night, so she could keep an eye on him.
Mrs Bapu woke up at around 2.45am on the morning of April 2 and discovered that Adam was not breathing. He was rushed back to hospital but despite the attempts of his dad and paramedics to resuscitate him, Adam was pronounced dead at 4.03am.
Senior coroner Timothy Brennand asked Dr Shanmugam whether he would have done anything differently with the benefit of hindsight. He responded: “This is a question I keep asking myself and I have asked senior [doctors] and they said they would have done the same thing I did. I certainly don’t think I would do anything different, no.”
Pathologist Dr Melanie Newbould carried out a post mortem on Adam’s body and recorded the cause of death as sudden death in a child with laryngotracheobronchitis - more commonly referred to as croup. “We can tell that Adam definitely did have a significant respiratory tract infection affecting his airways at the time of his death,” she told the hearing.
Dr Newbould added that there was no evidence that Adam had developed sepsis, pneumonia or any other bacterial infection at the time of his death. “Everything seems to point to the fact he was a child with a very serious respiratory tract infection who suddenly collapsed and died,” she said.
Paediatric consultant Jessica Watson wrote a serious incident investigation report into the care that Adam received at Royal Bolton Hospital. She described his death as a “very rare and unfortunate set of circumstances”, adding that there were “many examples of excellent practice” and that Dr Shanmugam made “thorough” notes throughout his consultation.
Ms Watson said: “He would not have met the criteria of any intervention, medication, a prolonged period of observation or admission to hospital on the findings of his first attendance”.
During the hearing, Adam’s dad Soeb Bapu described his son as a “lovely” boy, who was “healthy” and “full of life”. He added: “He was very energetic and always asking questions.”
Recording a narrative conclusion, Mr Brennand said: “I’m of the view that his diagnosis was not unreasonable in the circumstances of the case, notwithstanding the benefit of hindsight. It appears to me that this was a judgement call based on the clinical presentation of Adam to the doctor, deploying what I can only describe as best practice in the auspices of his training and experience.
“He was of the view, and his clinical notes are nothing short of excellent, that this did not warrant, nor did the clinical presenting symptoms necessitate an admission onto ward for ongoing observation or escalated care.”
Mr Brennand added: “I don’t think anything more could or should have been done by the parents in terms of what happened when he got back home. It was obvious they were taking the best care that they could offer to him. No parent could have done any more than those two did.”
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