Why Children with Severe Bacterial Infection Die: A Population–Based Study of Determinants and Consequences of Suboptimal Care with a Special Emphasis on Methodological Issues

摘要: Introduction Suboptimal care is frequent in the management of severe bacterial infection. We aimed to evaluate consequences suboptimal early infection children and study determinants. Methods A previously reported population-based confidential enquiry included all (3 months- 16 years) who died a French area during 7-year period. Here, we compared optimality these cases that pediatric patients survived same period for 6 types care: seeking medical by parents, evaluation sepsis signs detection disease physician, timing dosage antibiotic therapy, saline bolus. Two independent experts blinded outcome final diagnosis evaluated types. The effect on survival was analyzed logistic regression adjusted confounding factors identified causal diagram. Determinants were multivariate multilevel regression. Results significantly more 21 as with 93 survivors: 24% vs 13% (p = 0.003). most delay seek (20%), under-evaluation severity physician (20%) delayed therapy (24%). Young age (under 1 year) independently associated higher risk care, whereas being under paediatric emergency specialist or mobile unit general practitioner reduced risk. Conclusions had global negative survival. Suboptimal may be avoided better training primary physicians specifics medicine.