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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.

Original publication

DOI

10.3399/bjgp09X472520

Type

Journal

Br J Gen Pract

Publication Date

11/2009

Volume

59

Pages

819 - 824

Keywords

Acute Disease, Adolescent, Child, Child Mortality, Child, Preschool, Chronic Disease, Congenital Abnormalities, Critical Illness, Death, Sudden, Female, Humans, Immunization, Infant, Male, Neoplasms, Primary Health Care, Quality of Health Care, Social Support, United Kingdom