Reporting on Paediatric Sepsis: Records Checklist for Experts

In civil litigation involving alleged diagnostic delay in paediatric sepsis in England and Wales, the expert’s ability to conduct a rigorous analysis under CPR Part 35 depends upon the completeness and chronological integrity of the primary medical records. Sepsis in children is a clinical state that may present with non-specific symptoms; minor omissions in documentation can obscure critical decision-making points, complicating the expert’s task of evaluating breach of duty and causation.

The Core Records Checklist

To facilitate a robust expert opinion, the following categories of documentation are essential. Incomplete disclosure often necessitates further applications for specific discovery, leading to procedural delays.

• Pre-hospital and Primary Care Records: GP notes, out-of-hours service reports, and records from NHS 111 or equivalent telephone triage. These provide the baseline clinical picture before the child presented to an acute unit.
• Ambulance and Paramedic Data: Electronic Patient Care Records (ePCR) including initial vital signs, Glasgow Coma Scale (GCS) assessment, and the rationale for transfer urgency.
• Hospital Admission Documentation: Triage notes, initial nursing observations, and the first medical assessment. Detailed recording of the time concerns were first raised is critical for assessing the timeline.
• Observation Charts and Fluid Balance: Consecutive sets of vital signs, including respiratory rate, capillary refill time, heart rate, and oxygen saturation. These should be cross-referenced with contemporaneous clinical notes to examine decision-making at the time.
• Pathology and Imaging Reports: Full laboratory results, including haematology, inflammatory markers, blood gases, and lactate levels. Imaging records are relevant to exclude alternative foci of infection.
• Medication Charts: A record of fluid administration and the timing of antibiotic delivery.
• Consultant/Senior Review Notes: Records of escalations, internal transfers (e.g., from A&E to a paediatric assessment unit or PICU), and the seniority of the clinicians involved.

Distinguishing Clinical Findings from Breach

An expert in paediatric sepsis must distinguish between an unfortunate clinical outcome and a failure to meet the standard of care. Expert review focuses on whether the clinical response was reasonable based on the information available to the clinician at the time. A retrospective diagnosis of sepsis does not automatically establish that the clinicians breached their duty of care. The expert must assess whether the signs and symptoms were sufficiently clear at the time of assessment to warrant a different management pathway, considering the physiological variations common in children.

Causation and Alternative Explanations

Causation in sepsis cases requires an assessment of whether the outcome would likely have been different had the standard of care been met. This involves determining whether an earlier intervention—such as fluid resuscitation or intravenous antibiotics—would have altered the physiological trajectory of the illness. Experts also consider alternative explanations for the child’s deterioration, such as underlying comorbidities or concurrent viral conditions that may mask or mimic the symptoms of bacterial sepsis.

Evidential Limitations and Procedural Context

Experts should be aware that hospital records may be incomplete or contradictory. Where documentation is absent, the expert must clarify the limitations this imposes on their opinion, distinguishing between what the records show and what the expert is assuming for the purpose of their analysis. Under CPR Part 35, the expert’s primary duty is to the court, and they must remain impartial. If an expert finds the documentation insufficient to reach a firm conclusion, they should state this clearly.

Structuring Instructions for the Expert

To assist the expert, instructing solicitors should consider the following during the briefing process:

• Ensure the chronology is indexed, paginated, and provided in a searchable electronic format.
• Identify the specific time window where the alleged delay occurred.
• Provide clarity on the relevant jurisdiction, noting that procedural requirements vary outside England and Wales civil courts.
• If seeking opinions from multiple disciplines, ensure that instructions are consistent. Where the court directs a discussion between experts under CPR 35.12, the experts should prepare a joint statement. Note that a single joint expert (appointed under the court’s power in CPR 35.7 and instructed under CPR 35.8) does not participate in a joint statement process with a second expert, as they are the sole source of evidence for that discipline.

For those requiring assistance in identifying appropriate expertise for clinical negligence cases, consult the team at Paediatric Experts to discuss the specific requirements of your case.