North Carolina – Physician Assistant – 10-Year-Old With Cough, Fever, High Blood Pressure, and Sore Throat Diagnosed With Strep Throat

The Board was notified of a professional liability payment made on 1/28/2016.

A 10-year-old presented to a physician assistant with a chief complaint of cough, headache, sore throat, and fever.  The patient’s blood pressure was elevated, 140/190, and she had a fever of 103.2 degrees F.  According to the history, the patient denied nausea, vomiting, or diarrhea.  In the physical examination, it was documented a normal respiratory assessment.  The patient was diagnosed with strep throat, prescribed amoxicillin, and the patient was discharged home.

The patient died two days later from pneumonia secondary to influenza infection, which was not listed in the differential diagnosis.

The Board expressed concern that the physician assistant did not consider influenza in the differential diagnosis, prescribed an antibiotic without identifying the pathogen responsible for the infection, and did not perform a blood pressure recheck for the patient’s hypertension.  The Board noted a failure to document providing adequate follow up instructions to the patient’s family enumerating red flag signs and symptoms which would prompt the family to return the child to a health care facility.

The Board issued a public letter of concern, which was reported to the Federation of State Medical Boards.  It was not reported to the National Practitioner Data Bank.

State: North Carolina

Date: April 2017

Specialty: Physician Assistant, Emergency Medicine, Pediatrics

Symptom: Fever, Cough, Headache

Diagnosis: Pneumonia

Medical Error: Diagnostic error, Lack of proper documentation

Significant Outcome: Death

Case Rating: 3

Link to Original Case File: Download PDF

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