Described as once “healthy and strong”, Briony Caitlin Klingberg had visited many doctors before she died from a herpes simplex virus (HSV) infection two years ago. The virus was only detected through a liver biopsy after her death.

South Australian coroner Mark Johns said “no single medical professional” had the opportunity to observe the progress of the girl’s illness and her deteriorating condition.

Misdiagnosis from visits to multiple doctors

When Briony started feeling feverish, her mother, Bridget Klingberg, took her to the Adelaide Women’s and Children’s Hospital where a senior doctor, Davinder Gill, detected small ulcers in her throat, and advised the girl to either stay for observation or go home if the family so preferred.

In his findings, the coroner revealed, "She said that she and her husband had the sense that they should not come back unless Briony got worse."

"As a result, they would decide not to return to the Women's and Children's Hospital. Instead, they took her to the local hospital at Mount Barker on the assumption that they would advise to take Briony to the Women's and Children's Hospital if that was necessary."

At Mount Barker Hospital, Briony was diagnosed with a virus infection, and given prednisolone. The doctor had asked to see her again the next day. During that visit, he felt the girl’s condition had improved slightly.

"Mrs Klingberg said that she did not believe that Briony was better, but wanted to believe that it was true," Johns disclosed.

"She did not argue and accepted the doctor's advice to take Briony home and keep up the fluids and medications, including the prednisolone.”

Johns felt that if they had returned to the first hospital, it would have enabled a proper follow-up of her condition.

“Such a comparison would likely have raised concerns and prompted further investigations.”

Family GP did not take appropriate notes of “odd” test results

Their family doctor, Christopher Heinrich, who attributed her symptoms to glandular fever, gave the girl an injection of antibiotics and ordered a blood test.

The coroner said that Heinrich had failed to take notes on observations during the consultation. He added that the doctor took delivery of significant blood results by phone without writing them down and should have referred her to the hospital immediately.

“In saying these things I acknowledge the evidence that by then it would, in all likelihood, have been too late to save Briony’s life,” Johns added.

“Nevertheless, it is a matter of serious concern that he did not act appropriately as he should have done.”

Continuity of care important for accurate diagnosis

Seeing that the girl remained unwell and had difficulty urinating, Heinrich referred her to the Women's and Children's Hospital. However, Briony collapsed in the parking lot before reaching the emergency department, and was put in intensive care where she passed on the next day.

The court said that Gill had conceded he should have made a different diagnosis, but would not have greatly changed Briony's treatment.

"Dr Gill said that he has seen HSV many times and that it is a common illness, although less so in Briony's age group," the coroner said.

"He said that he thought that the small ulcers that he saw in Briony were slightly unusual, but not outstandingly so, and were consistent with pharyngitis."

On the other hand, the doctor at Mount Barker Hospital, Christopher Say, was described by the coroner as "caring and conscientious" and was "clearly very distressed about Briony's tragic death". In light of Briony’s untimely death, Johns stressed the importance of continuity of medical care and suggested a community campaign which could keep parents better informed.

"In making these observations I stress that I am not being critical of Briony's mother and father in any way whatsoever," said Johns.

"It is important that the Women's and Children's Hospital and all other practitioners dealing with children try to encourage parents and carers to have the confidence to return in order to avoid discontinuity of care." MIMS

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Sources:
http://www.abc.net.au/news/2017-02-01/herpes-death-coroner-findings-on-briony-klingberg/8229588
http://www.australianherald.com/index.php/sid/251379555
http://www.smh.com.au/national/health/tenyearold-briony-klingberg-died-from-herpes-virus-after-lack-of-continuous-care-sa-coroner-finds-20170201-gu33ot.html
http://www.adelaidenow.com.au/news/south-australia/womens-and-childrens-hospital-consultant-paediatrician-dr-davinder-gill-gives-evidence-into-death-of-10yearold-briony-klingberg/news-story/59cc843644fba21c0f1ba9a20e3f9b87