Schoolgirl died after '4 doctors failed to spot appendicitis' with coroner sounding alarm

A coroner has sounded the alarm over medical training after four doctors failed to spot appendicitis in a schoolgirl who later died. Lacey Brookman's appendix is believed to have burst before her initial GP appointment, but her condition wasn't diagnosed for another two weeks.

The 11-year-old underwent surgery at King's College Hospital in South London to remove her appendix, but she sadly died after suffering multi-organ failure due to complications in June 2021, an inquest heard. Three doctors missed the illness, while another could not reach a diagnosis, London Inner South Coroner's Court heard.

Now, Senior Coroner Dr Julian Morris has issued a Prevention of Future Deaths Report highlighting the missed opportunities to diagnose appendicitis. Dr Morris said there is a lack of "knowledge and awareness" and called for out of hours ultrasound scanning.

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The court heard Lacey, from Great Yarmouth, Norfolk, had suffered 10 days of stomach pains, nausea, vomiting, constipation, and fever, when her mum had a phone consultation with the GP. Some of the symptoms appeared to be settling and she was diagnosed with a virus and given safety netting advice.

Three days later she presented to another GP who diagnosed her with appendicitis. When she was transferred to A&E, however, the registrar dismissed the diagnosis and reached their own conclusion, arranging for a review later that day.

She went home at around 2am then returned to be seen by a consultant who could not reach a diagnosis. He arranged for an urgent ultrasound which revealed a burst appendix, which had likely happened before her original GP call.

She was sent to a specialist paediatric unit for surgery the next day, but developed an intestinal ulcer and bleeding disorder due to her condition. The appendix was removed by post-operative complications resulted in further operations and multi-organ failure.

Despite input from two further hospitals, she died at 5:25pm on June 4, 2021. The inquest heard her type of appendicitis 'occurs in about one-third of acute appendicitis presentations' and that 'it is difficult to determine as its presentation is not ‘classical’ in terms of right sided abdominal pain and presenting symptoms'. This means it can present late after bursting and the availability of an ultrasound is 'critical' in reaching a diagnosis.

Dr Morris said: "From the evidence I heard in court, I do not consider there is sufficient knowledge and awareness and therefore consideration from junior staff in relation to this particular type of presentation of acute appendicitis. In addition, the importance of carrying out an abdominal ultrasound (+/- CT) was highlighted. The evidence was that this could only be provided by the on-call radiologist, which therefore restricted its availability and assistance in making the diagnosis."

The coroner also raised four major concerns:

• Neither the original GP, the reviewing surgical SHO or surgical registrar considered that Lacey had appendicitis. The Consultant surgeon reviewing Lacey on the 24th, considered she was ill but could not reach a diagnosis.

• Despite the slant of available literature, it was evident retrocaecal appendicitis presentation is not a rare presentation of either acute appendicitis or generalised abdominal pain (both common presenting features in the young)

• The availability and use of bedside/departmental ultrasound scanning in abdominal pain (e.g. in the young) at any time, but especially out of hours

• The training of doctors in considering the diagnosis as a possible differential to generalised abdominal pain.

The PFD report was sent to Royal College of General Practitioners, Royal College of Paediatricians and Child Health, Royal College of Surgeons, and Royal College of Radiologists. They were due to respond by Monday (November 12).

A GoFundMe page set up in tribute to Lacey, describing her as having a 'lovely smile, calm nature and kind heart', has raised £3,795. King's College Hospital was approached for comment.

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