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Learning from errors
CASE REPORT
A severe deep neck odontogenic infection not prioritised by the emergency department triage system and National Early Warning Score
  1. Emma Wates1,
  2. James Higginson2,
  3. Andre Kichenaradjou3,
  4. Kieron McVeigh3
  1. 1University of Bristol Medical School, Bristol, UK
  2. 2Oral and Maxillofacial Surgery, Health Education England West Midlands, Edgbaston, UK
  3. 3Oral and Maxillofacial Surgery, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
  1. Correspondence to Miss Emma Wates, emma.wates{at}doctors.org.uk

Summary

A 62-year-old man with a background of type 2 diabetes mellitus presented to the emergency department (ED) with a 5-day history of dental pain, progressive right facial swelling, trismus, dysphagia and voice changes. The oropharynx could not be directly examined completely due to trismus. The patient had a National Early Warning Score of 0 and so was triaged into the ‘minors’ section of ED. Following assessment by the on-call oral and maxillofacial surgeon, an urgent contrast-enhanced CT demonstrated a large parapharyngeal collection, which required urgent anaesthetic and surgical intervention. The patient developed pulmonary complications postoperatively, but eventually made a full recovery.

  • dentistry and oral medicine
  • ear, nose and throat/otolaryngology
  • anaesthesia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2018-224634

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    Footnotes

    • Contributors EW: planning, conduct, reporting, conception and design, acquisition of data and interpretation of data. JH: planning, conduct, reporting, conception and design and interpretation of data. AK: conduct, reporting, conception and design and interpretation of data. KMV: conduct, reporting, conception and design and interpretation of data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.