A nine-year-old boy was discharged from the hospital with suspected flu symptoms just days before he tragically passed away from a ruptured appendix, an inquest heard.
Dylan Cope, who died on December 14, 2022, was taken to A&E with his parents due to abdominal pain, an inquest into his death was told.. The hearing, which took place at Gwent Coroner's Court on Monday, May 20, highlighted that Dylan, from Newport, was generally "fit and healthy" until he started feeling unwell with stomach pain and vomit-inducing sickness in the early hours of December 2022.
In a statement read on behalf of the boy's father, Laurence, Dylan was described as a "feisty and sensitive" boy who enjoyed activities like baking alongside his mother, wrestling with his sibling, and bouncing on a trampoline. He was further described as a warm and compassionate child who got exceptionally excited hearing Alexa's announcement about 'free hugs available in the lounge', rushing to receive one from the family members, Wales Online reports.
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Laurence described his deceased son as possessing a "quirky sense of humour" and relishing school subjects like computer coding and science. Lego structure creation and problem-solving were his distinct diversions.
His dad also pointed out how Dylan would routinely solve challenges such as completing a Rubik's cube by googling solutions or watching instructional videos via YouTube. His father added: "On the day we were meant to be proudly watching Dylan in his school Christmas play dressed as a little reindeer, instead we watched him dying."
The inquest was informed that Dylan had fallen ill on December 2 and had vomited, but by December 4 he seemed back to his normal self save for a slight cough. His parents decided to keep him at home from school, worried about him catching or transmitting illnesses such as Strep A.
By December 6, despite a cough and lower abdominal pain, Dylan took Calpol and ate his lunch normally, but later reported "excruciating" abdominal discomfort. Upon inspection, Dylan's GP noticed stiffness in his lower abdomen, known as 'guarding,' an indication of appendix inflammation, and promptly referred him to Grange Hospitals A&E department.
Upon arrival at the emergency room that night, Dylan was promptly assessed, while puzzled medical staff labelled his symptoms as a "mystery." After a nasal swab and urine analysis, he tested positive for influenza, the inquest heard.
After examination, another medic stated it was "highly unlikely" Dylan's appendix was responsible for his pain since the discomfort focused on the left side, opposite to the appendix's location. After being discharged after 1am on December 7, 2022 with instructions for treating a cough and cold, Dylan's father was given advice to administer Calpol and allow Dylan enough rest time, whilst also reassuring him that improvement should be seen in the upcoming days.
However, Dylan's condition worsened; he continued to experience intermittent bouts of abdominal pain, couldn't attend school, and lost all appetite, the inquest heard. On December 10, 2022, Dylan's family grew increasingly worried about his condition and dialled the emergency number they were given upon leaving the hospital.
After 19 attempts, they finally got through at 11.41am, only to be directed to call the NHS 111 number. Dylan's father called 111, and while on hold, they noticed Dylan's breathing was becoming more rapid.
He waited for over two hours before finally getting through at 2.45pm. He reported that his son had cold hands and feet, and was informed by the operator that a doctor would return their call.
However, when Dylan started complaining of leg pain, his parents decided to rush him to A&E. His father Laurence drove him, while his mother Corrine followed after arranging childcare for their other two children.
The inquest heard they arrived at the Grange Hospital at 4.10pm. From there, Dylan was transferred to the University Hospital of Wales where he underwent an appendectomy. Tragically, he passed away four days later on December 14.
The initial medical cause of death was listed as septic shock with multi-organ dysfunction, caused by a perforated appendix. Paediatric nurse practitioner Samantha Hayden, speaking at the inquest, recounted how she assessed Dylan at the Grange around 10pm on December 6, 2022.
Her assessment included a nose swab but did not involve consulting the GP referral for Dylan beforehand. She explained that while the referral would have served as a "guide" the hospital was "exceptionally busy" that evening, and with computers needed to review the referral being in rooms occupied by patients, she prioritised assessing Dylan.
Hayden mentioned she "doesn't recall" asking about the severity of Dylan's abdominal pain but did note he repeatedly said the pain was worst on the left side. She observed swollen lymph nodes and congestion in his throat, describing his symptoms as a "mixed bag" that could point to several conditions, such as flu, appendicitis, or peritonitis.
She also noted that Dylan had tested positive for influenza. Senior Coroner Caroline Saunders questioned Ms Hayden about her omission of Dylan's lower right abdominal pain from her statement, to which she responded: "I'm not sure."
When asked whether knowledge of the GP's referral pointing to possible appendicitis would have changed her approach, she said it wouldn't - she had already considered appendicitis among other potential causes for Dylan's ill health.
In terms of diagnostic processes, Ms Hayden told the coroner she did not request a blood test because of the "number of differentials" in symptoms that Dylan presented with. She explained that she'd discussed various potential diagnoses with Dylan's father.
Ms Hayden then went on to outline her decision to complete a discharge summary before a planned senior review could be carried out on Dylan by another healthcare professional. Responding to queries from Ms Saunders about whether this suggested a pre-determined diagnosis, Ms Hayden stated that these summaries are ordinarily "pre-empted", adding that an impending senior review does not necessarily need to be included in such summaries.
Additionally, Peter Bassett, a nurse present at the time, gave evidence, stating that he was informed after midnight that Dylan could be discharged. He was provided with a discharge number for Dylan and documentation stating that the child was suffering from flu-like symptoms.
Furthermore, instructions were given for Dylan to receive a cold and cough informational leaflet. He recalled advising Dylan's father that his son should be given food, drink and sugar to aid his recovery.
When asked about the abdominal pain, he remembered saying "if it didn't go with pain relief or changed to come back." Mr Bassett was questioned if he knew that Dylan initially came to the hospital due to abdominal pain, to which he responded he didn't. Upon being asked if he had seen this information on the discharge sheet filled out by Ms Hayden, he confessed that he "didn't read the whole" sheet other than what he deemed relevant to Dylan's symptoms.
Ms Saunders queried, "How can you tell whether it's relevant or not unless you read it? " She pointed out that the sheet "amounted to half a dozen lines" and wasn't lengthy, which Mr Bassett concurred with.
Mr Bassett acknowledged that Dylan appeared "looking tired" and "washed out" upon leaving the hospital. When asked if he verified whether a senior review by a healthcare professional had occurred before discharging him, he stated that he "assumed" it had based on his discussions with other staff members.
The inquest continues.
