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Original Papers

Child deaths: confidential enquiry into the role and quality of UK primary care

Anthony Harnden, Richard Mayon-White, David Mant, Deirdre Kelly and Gale Pearson
British Journal of General Practice 2009; 59 (568): 819-824. DOI: https://doi.org/10.3399/bjgp09X472520
Anthony Harnden
Roles: University Lecturer in General Practice
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Richard Mayon-White
Roles: Consultant Epidemiologist
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David Mant
Roles: Professor of General Practice
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Deirdre Kelly
Roles: Chair
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Gale Pearson
Roles: Clinical Director
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Abstract

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.

  • avoidable factors
  • child
  • death
  • primary health care
  • Received March 19, 2009.
  • Revision received April 15, 2009.
  • Accepted May 8, 2009.
  • © British Journal of General Practice, 2009.
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British Journal of General Practice: 59 (568)
British Journal of General Practice
Vol. 59, Issue 568
November 2009
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Child deaths: confidential enquiry into the role and quality of UK primary care
Anthony Harnden, Richard Mayon-White, David Mant, Deirdre Kelly, Gale Pearson
British Journal of General Practice 2009; 59 (568): 819-824. DOI: 10.3399/bjgp09X472520

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Child deaths: confidential enquiry into the role and quality of UK primary care
Anthony Harnden, Richard Mayon-White, David Mant, Deirdre Kelly, Gale Pearson
British Journal of General Practice 2009; 59 (568): 819-824. DOI: 10.3399/bjgp09X472520
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Keywords

  • avoidable factors
  • child
  • death
  • primary health care

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