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Published on: February 9, 2011
Why children with severe bacterial infection die: a population-based study of determinants and consequences of
Elise Launay1, Christèle Gras-Le Guen2, Alain Martinot3
1CHU Nantes, Hôpital de la Mère et de l'Enfant, Clinique médicale pédiatrique, Faculté de médecine de Nantes, Nantes, France; Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France.
Insights
Suboptimal care in managing severe bacterial infections in children significantly impacts survival rates. Improving physician training in pediatric medicine can help prevent these critical errors.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Management
- Patient Safety
Background:
- Severe bacterial infections pose a significant threat to children's health.
- Suboptimal care is a frequent issue in managing these infections.
- Understanding the impact and causes of suboptimal care is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the consequences of suboptimal care in the early management of severe bacterial infections in children.
- To identify the determinants associated with suboptimal care in pediatric patients.
Main Methods:
- A population-based study compared care optimality in children who died versus those who survived severe bacterial infections.
- Six key care aspects were evaluated by blinded experts: parental care-seeking, physician evaluation, and antibiotic/saline therapy timing and dosage.
- Logistic regression and multivariate multilevel logistic regression were used to analyze the effect of suboptimal care on survival and its determinants.
Main Results:
- Suboptimal care was more frequent in children who died (24%) compared to survivors (13%).
- Common suboptimal care included delayed medical care seeking, under-evaluation of severity, and delayed antibiotic therapy.
- Younger age (under 1 year) increased the risk of suboptimal care, while specialist care reduced this risk.
Conclusions:
- Suboptimal care in the early stages of severe bacterial infection negatively affects survival.
- Enhanced training for primary care physicians in pediatric medicine is recommended to reduce avoidable suboptimal care.
Introduction:
Suboptimal care is frequent in the management of severe bacterial infection. We aimed to evaluate the consequences of suboptimal care in the early management of severe bacterial infection in children and study the determinants.
Methods:
A previously reported population-based confidential enquiry included all children (3 months- 16 years) who died of severe bacterial infection in a French area during a 7-year period. Here, we compared the optimality of the management of these cases to that of pediatric patients who survived a severe bacterial infection during the same period for 6 types of care: seeking medical care by parents, evaluation of sepsis signs and detection of severe disease by a physician, timing and dosage of antibiotic therapy, and timing and dosage of saline bolus. Two independent experts blinded to outcome and final diagnosis evaluated the optimality of these care types. The effect of suboptimal care on survival was analyzed by a logistic regression adjusted on confounding factors identified by a causal diagram. Determinants of suboptimal care were analyzed by multivariate multilevel logistic regression.
Results:
Suboptimal care was significantly more frequent during early management of the 21 children who died as compared with the 93 survivors: 24% vs 13% (p = 0.003). The most frequent suboptimal care types were delay to seek medical care (20%), under-evaluation of severity by the physician (20%) and delayed antibiotic therapy (24%). Young age (under 1 year) was independently associated with higher risk of suboptimal care, whereas being under the care of a paediatric emergency specialist or a mobile medical unit as compared with a general practitioner was associated with reduced risk.
Conclusions:
Suboptimal care in the early management of severe bacterial infection had a global independent negative effect on survival. Suboptimal care may be avoided by better training of primary care physicians in the specifics of pediatric medicine.
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