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PEDIATRICS Vol. 110 No. 2 August 2002, pp. e18-e18

ELECTRONIC ARTICLE

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

Tessa L. Crume, MSPH^*, Carolyn DiGuiseppi, MD, MPH, Tim Byers, MD, MPH, Andrew P. Sirotnak, MD, FAAP^|| and Carol J. Garrett, PhD^¶

^* Colorado Department of Public Health and Environment, Denver, Colorado
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Colorado Injury Control Research Center, Denver, Colorado
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
^|| Department of Pediatrics, University of Colorado Health Sciences Center, The Children’s Hospital and Kempe Children’s Center, Denver, Colorado
^¶ Health Statistics and Vital Records and Colorado Department of Public Health and Environment, University of Colorado Health Sciences Center, Denver, Colorado

Objective. 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.

Methods. 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.

Results. 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.

Conclusions. 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.

Key Words: child abuse • death certificates • vital statistics • mortality • infant mortality • data collection • public health, records • logistic models • statistical models • cause of death • child welfare • battered child syndrome • child advocacy • infanticide

Abbreviations: CFRC, child fatality review committee • ICD, International Classification of Diseases • SES, socioeconomic status

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Received for publication Dec 17, 2001; Accepted Apr 15, 2002.

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