Millie Creasy

(1) Millie was admitted to the Luton & Dunstable Hospital on 31 July 2018 at 14.42 hours having suffered a prolonged seizure of approximately 30 minutes which paramedics described as decorticate. She was subsequently discharged at 20.40 hours for with an appointment for review the following day (regular neurological observations had ceased after 2 hours); (2) Whilst my factual findings recognised that any earlier treatment for raised ICP may not have altered the outcome, and that a diagnosis of raised ICP or the risk of raised ICP is a clinical one, I was informed that it was not possible for the Luton & Dunstable NHS Trust to be more prescriptive in terms of clinical treatment in cases where a child presents with a history of prolonged seizure and that, in any event, “the Trust did not have stronger evidence that a longer period of observation would help as neuro-observations will only detect the late situation when cerebral oedema has reached the point of coning/tonsillar herniation when intervention is often not effective. Additional interventions would only occur when the process is advanced enough for clinical detection and the outcome is poor” ; (3) During the Inquest, I heard evidence from , Paediatric Intensivist, at St Mary’s Hospital, London. Both the Pathologist and agreed that an prolonged seizure can cause a hypoxic brain injury that may not become clinically apparent for hours or even days. also explained that if Millie’s condition had been identified at the stage of ‘peri-herniation’, she would have received neuroprotective procedures which would have improved her chances of survival; I have since been provided with a copy of the Imperial College Healthcare NHS Trust Guideline (Drafted by

): Neuroprotection for the patient on the Paediatric Intensive Care Unit. The scope of the guideline is said to be the multi-protection team working in any area of Paediatrics and states that: “Whenever a patient has suffered a neurological insult or is at risk of primary (cellular damage leading to cell death) or secondary neurological injury (further cellular and structural injury) neuroprotective strategies should be commenced. Clinical situations where this should be considered include the following: Traumatic Brain Injury Sepsis – prolonged hypotension Sepsis – meningitis, encephalitis Post-cardiac arrest Any CNS insult – prolonged seizures Metabolic derangements – sodium, glucose, ammonia Liver failure – encephalopathy”; (4) Although the evidence suggested Millie had suffered a prolonged seizure, there was no evidence to suggest the potential need for neuroprotective strategies was, in fact, considered by the Luton & Dunstable NHS Trust.