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Frederick Squires

Ref: 2016-0389 Date: 31 Oct 2016 Coroner: Thomas Osborne Area: Milton Keynes Responses identified: 1 / 1 View PDF

A lack of clear clinical guidance on when to reintroduce Warfarin after a head injury risks either premature commencement leading to bleeding, or delayed commencement causing stroke.

Date 31 Oct 2016
56-day deadline 26 Dec 2016
Responses identified 1 of 1
Hospital Death (Clinical Procedures and medical management) related deaths Road (Highways Safety) related deaths

Coroner's concerns

AI summary
A lack of clear clinical guidance on when to reintroduce Warfarin after a head injury risks either premature commencement leading to bleeding, or delayed commencement causing stroke.
View full coroner's concerns
to give clear guidance.

(1) That there is no guidance available to clinicians as to when Warfarin should be recommenced for a patient who has suffered a head injury. If clear guidance is not available it will lead to confusion amongst clinicians and the patient with the result that it is commenced too soon and the patient develops a bleed or too late and the patient suffers a stroke.

HM Coroners Office, Civic Offices, 1 Saxon Gate East, Central Milton Keynes, MK9 3EJ Tel 01908 254326 | Fax 01908 253636

Responses

1 respondent
National Institute for Health and Care Excellence Other
23 Nov 2016 PDF
Action Planned

NICE acknowledges the lack of guidance on when to restart Warfarin after a head injury. They will consider extending the scope of their existing head injury guideline in 2017 to address this. (AI summary)

View full response
Dear Mr Osborne, I write in response to the Regulation 28 Report into the death of Mr Frederick Squires. I was very sorry to learn of Mr Squires’ death. You explain in your report that there is no guidance available to clinicians as to when Warfarin should be recommenced fora patient who has suffered a head injury. You subsequently have concerns that if clear guidance is not available it will lead to confusion amongst clinicians and the patient, with the result that it is commenced too soon and the patient develops a bleed, or too late and the patient suffers a stroke. We have considered the circumstances around Mr Squires’ death and the concerns you have raised. We have a guideline on the assessment and early management of head injury (accessible from our website: www.nice.org.uk/cg176), which includes recommendations regarding discharging patients. However, we believe that to examine the available evidence and make specific recommendations on when to restart Warfarin would require the guideline’s scope to be extended. We will consider the case for doing so, when we consider the guideline for updating in 2017

Report sections

Investigation and inquest
On 15/01/2015 I commenced an investigation into the death of Frederick Squires, 87. The investigation concluded at the end of the inquest on 13/10/2016. The conclusion of the inquest was a Narrative conclusion as attached.
Circumstances of the death
On 4th December 2014 Mr Squires was involved in a road traffic collision where he was struck by the rear of a slowly reversing vehicle. The collision was low impact but on falling to the floor, Mr Squires struck his head. He was taken to Milton Keynes Hospital where a CT was performed and his warfarin and medications were stopped. He was admitted to ward 19 on 5th December 2014 and was discharged home on 6th December 2014 with instructions to see his GP as an outpatient to arrange another CT scan and he was not to start taking his medications until the results of the second CT scan were available. His second CT scan was booked for 29th December 2014.

Early on the morning of the 21st December 2014 the deceased was found on the toilet in the bathroom. An ambulance was called and the deceased was taken to the Luton and Dunstable hospital where a CT scan of his head showed he had an acute ischaemic stroke. He died on the 30th December 2014. has maintained that she was concerned at the withdrawal of all his medications and had expressed this on several occasions.

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Report details

Reference
2016-0389
Date of report
31 October 2016
Coroner
Thomas Osborne
Coroner area
Milton Keynes

Responses identified

Responses identified 1 of 1
All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 26 Dec 2016.

Sent to

N.I.C.E

Source links

Judiciary.uk page → Report PDF →

Data: judiciary.uk under OGL.