Department of Primary Health Care, University of Oxford, Oxford.
Br J Gen Pract. 2009 Nov;59(568):819-24. doi: 10.3399/bjgp09X472520. Epub 2009 Sep 2.
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.
To review the role and quality of primary care in child deaths.
Confidential enquiry into child deaths.
Five regions of the UK: North-East, South-West and West Midlands, Wales, and Northern Ireland.
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.
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.
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.
2006 年，孕产妇和围产儿死亡机密调查扩展至试点儿童死亡病例收集。这有助于优化当地儿童保护委员会的数据收集工作，自 2008 年 4 月起，该委员会有审查所有儿童死亡的法定责任。审查初级保健记录可以突出系统、技能和护理方面可以改进的领域。
审查初级保健在儿童死亡中的作用和质量。
儿童死亡机密调查。
英国五个地区：东北地区、西南地区和西米德兰兹、威尔士和北爱尔兰。
机密调查收集了所有儿童死亡（年龄在 28 天至 17 岁之间）的核心数据，并由多学科小组对可避免因素进行了分层抽样评估。对东北地区所有儿童和其他四个地区由小组审查的所有儿童的初级保健记录进行了独立的详细审查。
对 168 例儿童死亡进行了初级保健记录审查。有 25 例（15%）死于急性感染，22 例（13%）死于癌症，11 例（7%）死于哮喘或癫痫。59 例（35%）死亡为突然死亡：婴儿猝死、自杀和袭击。在有免疫记录的 149 例中，只有 88 例（59%）按时完全接种疫苗。有 90 例（54%）儿童的管理涉及一位或多位初级保健专业人员。在这些死亡中，有 18 例（20%）确定存在可避免的初级保健因素。可避免的初级保健因素包括对严重感染的识别和管理失败、未接种疫苗以及对哮喘和癫痫的管理不足。
在初级保健中做出的诊断和管理决策可能会影响儿童死亡的原因、时间和情况。保持评估急性疾病儿童的技能仍然是良好临床实践的重要组成部分。
