Child Fatality Review Teams Research Articles

Unexplained infant death in Houston, TX: A 17-year retrospective

SIDS/SUID (henceforth referred to as SIDS) is a leading cause of neonate death, taking the lives of ~10 infants every day in the US alone. SIDS is defined as the death of an infant for which no cause of death can be determined after a complete autopsy, death scene investigation, and medical history review, all of which makes SIDS a very diffcult disease to study. Death scene investigations have identified several contributing environmental factors. However, etiological investigation has been complicated by inconsistencies in classification of death by medical examiners or coroners and unreliable resources for law enforcement to complete death scene investigations, which leads to epidemiological studies often lacking rigor or suffcient data. Using data from Child Fatality Review Team (CFRT) of Harris County, the Medical Examiner’s Offce, and the Texas Department of State Health Services, we performed a retrospective analysis of 17-years of SIDS cases in Harris County, Texas. We applied a novel birth rate correction for SIDS rates over the first year of life. Associations were tested using a Tukey HSD and linear regression models with co-linear factors considered. To focus on biologically unexplained SIDS cases, we subsetted our dataset to only include SIDS and Undetermined causes of death. Our preliminary data includes 1,094 cases comprised of ~43% black, ~32% Hispanic, ~20% white, ~3% Asian, and ~0.4% unknown and 57% male infants. Distribution of death across the first 12 months of life shows a peak of death around 2 months of age. We do not see an association with month or season in the raw SIDS data nor when using our novel correction for birth rates. When we apply the standard per 1,000 live births normalization, we see a significant increase in Spring and Winter. We also report race-dependent significant differences in yearly and monthly case numbers, male-to-female ratios, and age at death and additional significant race-dependent associations between SIDS cases and adults diagnosed with asthma, income level, and overcrowding based on Zip Code. This dataset represents one of the most racially and socio-economically diverse in the United States. Our data suggests that standard trends may be driven by majority white datasets and that response to socioeconomic stress varies by race/ ethnicity, which leads to differences in risk between classically described minority groups. NIH: 1F32HL160073-01A1, R01HL130249 44617-S4. BCM McNair Scholar Program, March of Dimes Basil O'Connor Research Award, Parker B. Francis Fellowship, CJ Foundation for SIDS. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Child Fatality Review.

Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.

Factors Associated with Child Maltreatment Fatality among Young Children with an Open Child Protective Services Case at Death

One of the goals of Child Protective Services (CPS) is to prevent maltreatment deaths. We analysed deaths of children younger than five years of age with an already open CPS case at the time of death for characteristics that might be associated with increased risk of fatality with child maltreatment. We used 2513 cases in the National Center for Fatality Review and Prevention – Case Review System during the years 2004–2016 for children ages 0–4 years who died with an already open CPS case. Among these, we compared 1370 children who died from causes determined to be ‘caused or contributed to’ by abuse or neglect to 1143 children who died from other causes. Those who died from maltreatment were older, experienced prior maltreatment, lived in an overcrowded residence, and had a caregiver with history of substance abuse, interpersonal violence, criminal delinquency and their own maltreatment. These risk factors and others may be associated with a higher likelihood of dying with abuse or neglect for children who already have an open CPS case.Key Practitioner Messages Compared with children dying from other causes, children with an already open CPS case at the time they died as a result of maltreatment were more likely to be older, male and living in a parental home with overcrowding. Caregivers were more likely to be male, or had a history of substance abuse, delinquency or prior maltreatment, both as a victim or perpetrator. When cases are opened with CPS, caseworkers should consider these potential risk factors and whether additional services can be put in place to reduce future maltreatment fatality. While additional research is needed, we speculate that other services, such as coordinated paediatric care, universal reporting, child fatality review teams, citizen review panels and public education campaigns, can offer additional ways to decrease future maltreatment deaths.

Older Adult Fatality Reviews: A Powerful Tool to Improve Policies, Protections, and Services

Older adult maltreatment is a serious problem that can hasten mortality and cause fatality. Child and Domestic Violence Fatality Review teams have made a major impact to improve protections, services, and system responses for victims. There are over 1300 child fatality review teams in 50 US states and 200 domestic violence fatality teams in 45 states. Older adult fatality reviews, in contrast, have not proliferated across the country, missing opportunities to bring interdisciplinary expertise together to resolve policy, protection, and services needed to prevent older adult premature deaths due to violence and abuse. Method: A mini mock review of a fatality of an older adult woman will demonstrate the possibilities of beginning Older Adult Fatality Review Board as recommended by the American Bar Association. Conclusion: Interdisciplinary older adult fatality review teams have been an underutilized tool to make changes in older adult mistreatment protection services and systems.

Surveillance for Violent Deaths - National Violent Death Reporting System, 32 States, 2016.

Surveillance for Violent Deaths - National Violent Death Reporting System, 32 States, 2016.

Surveillance for Violent Deaths - National Violent Death Reporting System, 27 States, 2015.

Surveillance for Violent Deaths - National Violent Death Reporting System, 27 States, 2015.

A Hospital-Based Initiative to Reduce Postdischarge Sudden Unexpected Infant Deaths.

Sudden unexpected infant deaths (SUID) most often occur because infants are placed in unsafe sleep environments. Although authors of previous literature have demonstrated that parents who receive comprehensive safe sleep education increase knowledge and intention to place children in safe sleep environments, no studies have demonstrated improved outcomes. We describe the development of a hospital-based newborn SUID risk reduction quality improvement project and its effectiveness in reducing subsequent SUIDs in a community using linked outcome data from local Child Fatality Review Teams. Qualitative and quantitative evaluation of a long-term iterative performance improvement intervention for a nursery-based comprehensive safe sleep program in a community teaching hospital. Key themes and exemplary comments were noted. The rate of infant deaths per 1000 births was the primary quantitative outcome. The rate is calculated quarterly and monitored with control charts by using Child Fatality Review data about infant sleep deaths. The average death rate fell from 1.08 infants per 1000 births preintervention to 0.48 infants per 1000 births after complete intervention, and the average number of deaths between deliveries increased from 1 in every 584 deliveries (upper control limit: 3371) to 1 in every 1420 deliveries (upper control limit: 8198). Qualitative observation of nursery providers revealed 3 themes, including routine inclusion of sleep safety information, dissemination of safety information by all staff, and personal commitment to success. A comprehensive sleep safety culture change can be effectively integrated into a nursery setting over time by using feedback from Child Fatality Review and performance improvement methodology. Repeated messaging and education by the entire nursery staff has the potential to play a role in reducing sleep-related deaths in infants born at their hospital.

Surveillance for Violent Deaths - National Violent Death Reporting System, 18 States, 2014.

Problem/ConditionIn 2014, approximately 59,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) regarding violent deaths from 18 U.S. states for 2014. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.Reporting Period Covered2014.Description of SystemNVDRS collects data from participating states regarding violent deaths. Data are obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 18 states that collected statewide data for 2014 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) into a single incident.ResultsFor 2014, a total of 22,098 fatal incidents involving 22,618 deaths were captured by NVDRS in the 18 states included in this report. The majority of deaths were suicides (65.6%), followed by homicides (22.5%), deaths of undetermined intent (10.0%), deaths involving legal intervention (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision (ICD-10) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Suicides occurred at higher rates among males, non-Hispanic American Indian/Alaska Natives (AI/AN), non-Hispanic whites, persons aged 45–54 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, substance abuse, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged <1 year and 15–44 years; rates were highest among non-Hispanic black and AI/AN males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or related to intimate partner violence (particularly for females). When the relationship between a homicide victim and a suspected perpetrator was known, it was most often either an acquaintance/friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20–44 years; rates were highest among non-Hispanic black males and Hispanic males. Precipitating factors for the majority of legal intervention deaths were alleged criminal activity in progress, the victim reportedly using a weapon in the incident, a mental health or substance abuse problem, an argument or conflict, or a recent crisis. Deaths of undetermined intent occurred more frequently among males, particularly non-Hispanic black and AI/AN males, and persons aged 30–54 years. Substance abuse, mental health problems, physical health problems, and a recent crisis were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm deaths were more frequent among males, non-Hispanic whites, and persons aged 10–24 years; these deaths most often occurred while the shooter was playing with a firearm and were most often precipitated by a person unintentionally pulling the trigger or mistakenly thinking the firearm was unloaded.InterpretationThis report provides a detailed summary of data from NVDRS for 2014. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. The primary precipitating factors for homicides and suicides were intimate partner problems, interpersonal conflicts, mental health and substance abuse problems, and recent crises.Public Health ActionNVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, North Carolina VDRS data were used to improve case ascertainment of pregnancy-associated suicides, Wisconsin VDRS data were used to develop the statewide suicide prevention strategy, and Colorado VDRS data were used to develop programs and prevention strategies for suicide among veterans. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

Surveillance for Violent Deaths - National Violent Death Reporting System, 17 States, 2013.

In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 17 U.S. states for 2013. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2013. NVDRS collects data from participating states regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 17 states that collected statewide data for 2013 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, North Carolina, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) from a single incident. For 2013, a total of 18,765 fatal incidents involving 19,251 deaths were captured by NVDRS in the 17 states included in this report. The majority (66.2%) of deaths were suicides, followed by homicides (23.2%), deaths of undetermined intent (8.8%), deaths involving legal intervention (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). (The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Suicides occurred at higher rates among males, non-Hispanic whites, American Indian/Alaska Natives, persons aged 45-64 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged 15-44 years; rates were highest among non-Hispanic black males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or were related to intimate partner violence (particularly for females). A known relationship between a homicide victim and a suspected perpetrator was most likely either that of an acquaintance or friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20-24 years and 30-34 years; rates were highest among non-Hispanic black males. Precipitating factors for the majority of legal intervention deaths were another crime, a mental health problem, or a recent crisis. Deaths of undetermined intent occurred at the highest rates among males and persons aged <1 year and 45-54 years. Substance abuse and mental or physical health problems were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm death rates were higher among males, non-Hispanic whites, and persons aged persons aged 15-19 and 55-64 years; these deaths were most often precipitated by a person unintentionally pulling the trigger while playing with a firearm or while hunting. This report provides a detailed summary of data from NVDRS for 2013. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. For homicides and suicides, intimate partner problems, interpersonal conflicts, mental health problems, and recent crises were primary precipitating factors. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, Utah Violent Death Reporting System (VDRS) data were used to develop policies that support children of intimate partner homicide victims, Colorado VDRS data to develop a web-based suicide prevention program targeting middle-aged men, and Rhode Island VDRS data to help guide suicide prevention efforts at workplaces. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

The Youth Nonfatal Violent Injury Review Panel: An Innovative Model to Inform Policy and Systems Change.

Among young people in the United States, nonfatal violent injuries outnumber fatal violent injuries by 171 to 1. The Child Fatality Review Team (CFRT) is a well-established model for informing injury prevention planning. The CFRT's restricted focus on fatal injuries, however, limits its ability to identify opportunities to prevent violent reinjury and address issues unique to nonfatal violent injuries. We adapted the CFRT model to develop and implement a Youth Nonfatal Violent Injury Review Panel. We convened representatives from 23 agencies (e.g., police, housing, and education) quarterly to share administrative information and confidentially discuss cases of nonfatal violent injury. In this article, we describe the panel model and present preliminary data on participants' perceptions of the process. Although outcomes research is needed to evaluate its impacts, the Youth Nonfatal Violent Injury Review Panel offers an innovative, promising, and replicable model for interagency collaboration to prevent youth violence and its effects.

Child Fatality Review

This Policy Statement was revised. See https://doi.org/10.1542/peds.2023-065481. Injury remains the leading cause of pediatric mortality and requires public health approaches to reduce preventable deaths. Child fatality review teams, first established to review suspicious child deaths involving abuse or neglect, have expanded toward a public health model of prevention of child fatality through systematic review of child deaths from birth through adolescence. Approximately half of all states report reviewing child deaths from all causes, and the process of fatality review has identified effective local and state prevention strategies for reducing child deaths. This expanded approach can be a powerful tool in understanding the epidemiology and preventability of child death locally, regionally, and nationally; improving accuracy of vital statistics data; and identifying public health and legislative strategies for reducing preventable child fatalities. The American Academy of Pediatrics supports the development of federal and state legislation to enhance the child fatality review process and recommends that pediatricians become involved in local and state child death reviews.

International Legal Note: Child fatality review teams and the role of social workers

We are living in dangerous and violent times, and our most precious resources, our children, are sometimes its victims. Disease, inadequate health care, violence, a faulty smoke alarm, an unlocked seat belt, a loaded gun, poison or medicine within easy reach, an unprotected electric outlet, a pack of matches: in rich countries and poor countries, all of these things can and have killed children (UNICEF, 2003). When these result in the death of a child, in a growing number of countries and jurisdictions the death is reviewed by a child fatality review team. The purpose is to perform a comprehensive review of child deaths in order to gain a better understanding of these deaths, and to use that knowledge to take preventative actions in similar situations.

Recommendations from child fatality review teams: results of a US nationwide exploratory study concerning maltreatment fatalities and social service delivery

AbstractMultidisciplinary child fatality review teams (CFRT) have existed in the United States (US) for almost 30 years; the products of the review process, however, remain unexamined. This study reviewed reports from CFRT throughout the US to compile and evaluate the identification of problems and recommendations by professionals concerning child maltreatment fatalities. Team‐ and state‐level data were also used for analysis to better understand the context in which recommendations are made. Over 300 recommendations for change from CFRT were grouped into 11 macro categories. The frequency of each type of recommendation and examples from each category are provided. The authors provide recommendations of their own for improvements in CFRT outputs. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Child Abuse Recognition and Reporting: Supports and Resources for Changing the Paradigm

As shown previously in the Child Abuse Recognition Experience Study (CARES), primary care providers reported that they decided not to report a substantial proportion of injuries that they suspected might have resulted from abuse. The most serious cases result in death. This article provides detailed reports of 2 illustrative cases from the author's experience as a member of a multidisciplinary child fatality review team and discusses several alternative legal mechanisms for improving mandated reporting. Regional centers of excellence in child protection may be an effective way of improving child protection; current proposals to establish such centers are reviewed.

Child fatality review: recommendations for state coordination and cooperation.

Preventable childhood injuries and deaths are a major public health problem in the United States. In 2000, the most recent year for which mortality data are available, over 10,000 children from birth to age 18 died from unintentional injuries in the United States and nearly 3,000 from the same age group died from homicide or suicide. According to theChildhood Injury Fact Sheetproduced by the Centers for Disease Control and Prevention (CDC), “unintentional injuries are the leading cause of death for children one to 21 years of age.”Preventing child fatalities requires further understanding of the causes and circumstances surrounding child deaths. One mechanism for doing this is multidisciplinary child fatality review teams. These teams exist at the state and local level and perform the functions of identifying, reviewing, and recommending preventive measures to reduce the number of preventable child deaths and life-threatening injuries.

Child Abuse Underestimated by Death Certificates

Child Abuse Underestimated by Death Certificates

Underascertainment of Child Maltreatment Fatalities by Death Certificates, 1990–1998

Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment. We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression. Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52-21.55) more likely to be ascertained than maltreatment by a parent. The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups.

Child fatality review: an international movement

Objective: This article discusses the multidisciplinary Child Fatality Review process in the US, Canada, and Australia, including common patterns, unique programs, changes over time, impact on multiagency systems, and future directions. Method: An open-ended survey was shared with teams listed in the directories of the Los Angeles County Inter-Agency Council on Child Abuse and Neglect National Center on Child Fatality Review (ICAN-NCFR). Responses were received from 58 state and local Child Fatality Review teams. Results: Teams exist in all 50 states, Washington, DC, most Canadian provinces, and New South Wales, Australia. Team structure varies but generally includes a similar core membership, and most teams select cases from coroner/medical examiner or vital statistics records through established protocols. While most case review is conducted by local teams, state teams may review cases because of small size or sparse population or choose to review specific types of cases (e.g., Child Protective Services). State teams often support local review through training, resources, policy development, and political assistance. An increasing number of teams collect data and issue reports, often published on the internet, allowing teams to share resources. Conclusions: Teams have matured with time, often broadening their intake spectrum, membership and data collection, and developing and following through with case management or systems change recommendations. Teams continue to improve multiagency interaction and are committed to the prevention of child injury and death. The number of teams, as well as their scope and expertise, continues to increase, developing into a national/international system.

The Role of Photo Documentation of Genital Findings in Medical Evaluations of Suspected Child Sexual Abuse

Results of a national survey of 104 nurse practitioners (NPs), registered nurses (RNs), and Physician Assistants (PAs) who conducted physical assessments in cases of suspected child physical abuse, neglect, and sexual abuse revealed that evaluation for suspected CSA was the type of evaluation conducted most often (92.5%), followed by physical abuse (70%), and neglect (54%). Most participants (76.9%) conducting CSA evaluations used a colposcope and interpreted colposcopic findings (70.2%). The mean number of years of speciality practice in CM reported by participants was 6, with a range of one to 20 years. While the majority (68%) of respondents were members of interdisciplinary child protection teams, only 10.7% were members of child fatality review teams. Although the vast majority (78.4%) of participants had testified in court on CM cases, most reported experiencing barriers to testifying in cases of CM. The barrier to testifying cited most often was a lack of credibility with the judicial system (60%), with 32% of respondents citing not being a physician (31%) as a major barrier in being accepted as an expert in CM. Implications for practice, policy, and future research are discussed.

SIDS prevention.

The mortality attributed to sudden infant death syndrome ahs decreased significantly in Northern Europe and Australia in conjunction with the majority of infants being placed to sleep on their back or side instead of on their stomach. Since the AAP recommendation in 1992 to place healthy infants on their back or side to sleep, the fraction of infants sleeping prone in the United States has decreased to approximately 43%. It is hoped that the national "Back to Sleep" education campaign will accelerate the acceptance of back or side sleeping for healthy infants so that only a small fraction of infants will be sleeping on their stomach within the next few years. Health-care providers should promote the recommendation in the newborn nursery and at well-baby visits. They should encourage dialogue with caregivers regarding this and other early infant care practices. It is still too soon to know how predominantly nonprone sleeping will affect the rate of SIDS in the United States. It is important that providers continue to stress access to prenatal and well-baby care, and cessation of smoking and substance abuse, as these risk factors may play a larger role in the high-risk communities in the United States. Pediatric medical personnel should advocate for proper death certification for infants and children, to include state legislation that supports autopsies for sudden unexpected deaths in children, and the establishment of state child fatality investigation and review teams. They also should participate in the training of death scene investigators or be part of the death scene investigative team.(ABSTRACT TRUNCATED AT 250 WORDS)