BACKGROUND: In 2006 the Confidential Enquiry into Maternal and Perinatal Deaths was extended to pilot a collection of child deaths. This helped optimise data collection for local safeguarding children's boards, which, since April 2008, have a statutory responsibility to review all child deaths. Reviewing primary care records may highlight areas in which systems, skills, and care could be improved. AIM: To review the role and quality of primary care in child deaths. DESIGN OF STUDY: Confidential enquiry into child deaths. SETTING: Five regions of the UK: North-East, South-West and West Midlands, Wales, and Northern Ireland. METHOD: The confidential enquiry collected core data for all child deaths (age range 28 days to 17 years) and an age-stratified sample was assessed by multidisciplinary panels for avoidable factors. An independent detailed review was conducted of the primary care records on all children in the North-East region and all children who were reviewed by panel in the other four regions. RESULTS: Primary care records were reviewed for 168 child deaths. There were 25 (15%) deaths from acute infection, 22 (13%) from cancer, and 11 (7%) from asthma or epilepsy. Fifty-nine (35%) deaths were sudden: sudden unexplained death in infancy, suicides, and assaults. Of 149 with immunisation records, only 88 (59%) had been fully vaccinated on time. One or more primary care professionals were involved in the management of 90 (54%) children. Avoidable primary care factors were identified in 18 (20%) of these deaths. Avoidable primary care factors included failure in the recognition and management of serious infection, failure to vaccinate, and inadequate management of asthma and epilepsy. CONCLUSION: Decisions made about diagnosis and management in primary care may affect the cause, time, and circumstances of a child's death. Maintaining skills in assessing the acutely ill child remains an essential part of good clinical practice.
BACKGROUND: In 2006 the Confidential Enquiry into Maternal and Perinatal Deaths was extended to pilot a collection of child deaths. This helped optimise data collection for local safeguarding children's boards, which, since April 2008, have a statutory responsibility to review all child deaths. Reviewing primary care records may highlight areas in which systems, skills, and care could be improved. AIM: To review the role and quality of primary care in child deaths. DESIGN OF STUDY: Confidential enquiry into child deaths. SETTING: Five regions of the UK: North-East, South-West and West Midlands, Wales, and Northern Ireland. METHOD: The confidential enquiry collected core data for all child deaths (age range 28 days to 17 years) and an age-stratified sample was assessed by multidisciplinary panels for avoidable factors. An independent detailed review was conducted of the primary care records on all children in the North-East region and all children who were reviewed by panel in the other four regions. RESULTS: Primary care records were reviewed for 168 child deaths. There were 25 (15%) deaths from acute infection, 22 (13%) from cancer, and 11 (7%) from asthma or epilepsy. Fifty-nine (35%) deaths were sudden: sudden unexplained death in infancy, suicides, and assaults. Of 149 with immunisation records, only 88 (59%) had been fully vaccinated on time. One or more primary care professionals were involved in the management of 90 (54%) children. Avoidable primary care factors were identified in 18 (20%) of these deaths. Avoidable primary care factors included failure in the recognition and management of serious infection, failure to vaccinate, and inadequate management of asthma and epilepsy. CONCLUSION: Decisions made about diagnosis and management in primary care may affect the cause, time, and circumstances of a child's death. Maintaining skills in assessing the acutely ill child remains an essential part of good clinical practice.
Authors: Matthew Thompson; Richard Mayon-White; Anthony Harnden; Rafael Perera; Diane McLeod; David Mant Journal: Br J Gen Pract Date: 2008-04 Impact factor: 5.386
Authors: Peter J Gill; Kay Yee Wang; David Mant; Lisa Hartling; Carl Heneghan; Rafael Perera; Terry Klassen; Anthony Harnden Journal: PLoS One Date: 2011-08-01 Impact factor: 3.240
Authors: Philippa Rees; Adrian Edwards; Colin Powell; Peter Hibbert; Huw Williams; Meredith Makeham; Ben Carter; Donna Luff; Gareth Parry; Anthony Avery; Aziz Sheikh; Liam Donaldson; Andrew Carson-Stevens Journal: PLoS Med Date: 2017-01-17 Impact factor: 11.069
Authors: Joanna C Crocker; Meirion R Evans; Christopher C Butler; Kerenza Hood; Colin V E Powell Journal: BMJ Open Date: 2012-09-04 Impact factor: 2.692
Authors: Peter Hodkinson; Andrew Argent; Lee Wallis; Steve Reid; Rafael Perera; Sian Harrison; Matthew Thompson; Mike English; Ian Maconochie; Alison Ward Journal: PLoS One Date: 2016-01-05 Impact factor: 3.240