DOI: 10.1097/01.pec.0000086243.54586.df

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PMID: 12972829

Issn Print: 0749-5161

Publication Date: 2003/08/01


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Pediatric Emergency Medicine: Legal Briefs

Steven M. Selbst

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On April 22, 1998, a 9-week-old male infant was evaluated at an Illinois emergency department (ED) with wheezing, coarse breath sounds, and abnormal vital signs. 1 Heart and respiratory rates were elevated, and temperature was 100.4°F. A sepsis work-up was not performed. The emergency physician discharged the infant with a diagnosis of mild viral upper respiratory tract infection. The physician gave the mother instructions to call the next day if the baby’s condition changed, and to follow up with the primary care physician. The mother did not call because the baby’s condition appeared to remain stable. However, the child died 43 hours later. An autopsy revealed bacterial pneumonia, bacteremia, and signs of sepsis.
The family sued and alleged the emergency physician failed to appreciate the instability of the vital signs, respiratory distress, and immune system compromise due to the infant’s age. They also alleged the doctor failed to take the infant’s temperature before discharge. The defense claimed that the child only suffered from a mild viral upper respiratory tract infection at the time of the ED visit and that he died from Sudden Infant Death Syndrome. The defense argued that the infant’s vital signs were within the normal limits for his age, his temperature was only mildly elevated, and he was experiencing no respiratory distress at the time of the visit. His oxygen saturation by pulse oximeter was 100% in room air, and albuterol aerosol therapy had little impact, so lower respiratory involvement was considered minimal. An expert witness testified the baby was at a higher risk of Sudden Infant Death Syndrome because of his age, gender, the cold weather, the fact that his mother smoked during the first trimester of her pregnancy, because his mother had been pregnant 8 times, because he had had the viral infection for a week, slept in a prone position, and slept with a parent. The defense also claimed the infant did not have evidence of multiorgan failure, bacterial infection in his lungs, or a course of progressive deterioration due to sepsis.
A jury returned a verdict in favor of the emergency physician. [Lake County (IL) Circuit Court, Cast No.
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