New guidelines to diagnose DVT

Key Quote: "If we keep looking at it and do not do anything, people are going to die the same as Katie died." Gordon McPherson, Katie's father.

DOCTORS are to receive new guidelines to help them tackle deep vein thrombosis, as senior medical staff admitted cases were being missed and new evidence emerged of a postcode lottery in treatment for the deadly condition.

National guidelines are being produced by health watchdogs following a critical report into the death of Katie McPherson, 23, from Renfrewshire. The student died after her GP and doctors at two different hospitals all failed to recognise that she was suffering from DVT.

Yesterday the president of the Royal College of Surgeons of Edinburgh admitted there was "a problem" and said doctors found "diagnosis [of DVT] difficult".

Evidence gathered by Ms McPherson's family and shown to The Scotsman revealed that of the 11 Scottish health boards who replied to freedom of information requests, every one had differing management protocols on how to diagnose DVT.

A spokesman for NHS Quality Improvement Scotland said the watchdog will carry out a major review of advice this winter before drawing up new guidelines next year. He added: "NHS QIS is fully committed to driving forward guidelines on the management of deep vein thrombosis during 2007 and this will run alongside revision of DVT prevention."

The Royal College of Surgeons of Edinburgh is also to meet colleagues from the Royal College of Physicians of Edinburgh in January to discuss establishing a set of new guidelines.

John Smith, president of the Royal College of Surgeons of Edinburgh, said: "We recognise there is a problem. Diagnosis is difficult because sometimes you overestimate the risk and some underestimate the risk. It is those kind of issues that we want to explore and provide advice so the diagnosis is clear and treatment can be gold standard.

"I think that is very important to have consistent guidelines for pulmonary embolisms."

The Royal Colleges were already considering looking at DVT guidelines because of the "recognised problems" in the NHS rather than as a direct result of the report into Ms McPherson's death.

Ms McPherson died in January 2003 of a pulmonary embolism after developing DVT. The occupational therapy student went to A&E at Edinburgh Royal Infirmary on 20 January with a painful lower leg. She was positive in one test for DVT and went on to have a venogram, which involves injecting a dye into a vein. The specialist registrar found no thrombosis, recording a "low probability of DVT".

Ms McPherson then saw her GP on 21 January who accepted the results of the tests and diagnosed a muscle injury. The following day she went to the A&E at the Royal Alexandra Hospital in Paisley, but was discharged and told to return if she got worse. On 26 January the student began suffering breathing difficulties and was taken by ambulance to hospital in Greenock but deteriorated rapidly and died.

Her parents always maintained their daughter was failed by the medical establishment. Earlier this year, Alice Brown, the Public Services Ombudsman, confirmed that belief.

Gordon McPherson, Katie's father, said national guidelines must be brought in to prevent another delay in diagnosis in Scotland.

He said: "If we keep looking at it and do not do anything, people are going to die the same as Katie died."

An investigation carried out by Ms McPherson's family found that most of Scotland's health boards have different guidelines and give out differing and often confusing patient information.

Following the series of freedom of information requests they discovered that, out of the 11 health boards that replied, all had differing guidelines on how to diagnose DVT and gave out different patient information leaflets.

They also found it was impossible to conclude how many patients had died of pulmonary embolism - a fatal condition often brought on by DVT - because health boards had different ways of calculating the figure and some had none at all.

According to the General Register Office in Scotland, 132 people died of pulmonary embolism last year but the family say the real figure is likely to be much higher since it is not always noted as a cause of death. In the UK 30,000 people are thought to die of Venuous Thromboembolism (VTE), the generic form of DVT, every year. Other cases in Scotland include Karen Johnstone, 28, from Kemnay, Aberdeenshire, who died in June this year from DVT after doctors at Aberdeen Royal Infirmary had given her the all-clear for the condition.

Carolanne Douglas, a 43-year-old mother of three from Edinburgh, died following a four-hour flight in August 2003.

She had initially complained of leg pains and was taken to St John's Hospital in Livingstone, where she was diagnosed with DVT, but doctors said it was only "superficial" and sent her home, where she died a week later.

"There is nothing we can do to bring Katie back, but what we can do is make sure this does not recur in other families," said Mr McPherson.