title: Suboptimal care in the initial management of children who died from severe bacterial infection: a population-based confidential inquiry.
abstract: OBJECTIVE
  To study the frequency and types of suboptimal care and medical errors in children who died of severe bacterial infection as the first-stage procedure intended to improve quality of care.
  
  
  METHODS
  Population-based confidential inquiry.
  
  
  METHODS
  Two adjoining administrative districts in France.
  
  
  METHODS
  Children older than 3 months dead from severe bacterial infection from 2000 through 2006.
  
  
  METHODS
  The medical files were summarized on standardized forms and then evaluated independently by two experts, who determined whether the initial management before the patients' arrival in intensive care was or was not optimal, in comparison with current guidelines.
  
  
  RESULTS
  Of 23 deaths from severe bacterial infection, 21 could be analyzed; management was considered suboptimal in 76%. The coefficient of agreement between the experts was high, with a weighted kappa of 0.73. The types of errors identified included parental delay in seeking medical care (33%; 95% confidence interval, [12-54]), physicians' delay in administering appropriate treatment (antibiotic therapy in the case of purpura; 38%; 95% confidence interval, 16-60), insufficient doses of or failure to repeat fluid resuscitation (24%; 95% confidence interval, [9 -35]), and overall underestimation of disease severity (38%; 95% confidence interval, [16-60]).
  
  
  CONCLUSIONS
  This study found a high frequency of suboptimal care in the initial management of children who died of severe bacterial infection, with four separate types of errors. Other studies are needed to assess the potential avoidability of this type of death.
authors.affiliation: Clinique médicale pédiatrique, Hôpital de la Mère et de l'Enfant, CHU Nantes, Nantes, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Launay
authors.forename: Christèle
authors.initials: C
authors.lastname: Gras-Le Guen
authors.forename: Alain
authors.initials: A
authors.lastname: Martinot
authors.forename: Rémy
authors.initials: R
authors.lastname: Assathiany
authors.forename: Thomas
authors.initials: T
authors.lastname: Blanchais
authors.forename: Nadjette
authors.initials: N
authors.lastname: Mourdi
authors.forename: Albertine
authors.initials: A
authors.lastname: Aouba
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bouvier-Colle
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Rozé
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D001424:Bacterial Infections / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index