title: Child deaths: confidential enquiry into the role and quality of UK primary care.
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.
  
  
  OBJECTIVE
  To review the role and quality of primary care in child deaths.
  
  
  METHODS
  Confidential enquiry into child deaths.
  
  
  METHODS
  Five regions of the UK: North-East, South-West and West Midlands, Wales, and Northern Ireland.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Primary Health Care, University of Oxford, Oxford. anthony.harnden@dphpc.ox.ac.uk
authors.forename: Anthony
authors.initials: A
authors.lastname: Harnden
authors.forename: Richard
authors.initials: R
authors.lastname: Mayon-White
authors.forename: David
authors.initials: D
authors.lastname: Mant
authors.forename: Deirdre
authors.initials: D
authors.lastname: Kelly
authors.forename: Gale
authors.initials: G
authors.lastname: Pearson
mesh_terms: D000208:Acute Disease / Q000401:mortality*; D000293:Adolescent; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D002908:Chronic Disease / Q000401:mortality*; D000013:Congenital Abnormalities / Q000401:mortality; D016638:Critical Illness / Q000401:mortality*; D003645:Death, Sudden / Q000453:epidemiology; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012944:Social Support; D006113:United Kingdom / Q000453:epidemiology