PEDIATRICS Vol. 91 No. 2 February 1993, pp. 330-337
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The Missouri Child Fatality Study: Underreporting of Maltreatment Fatalities Among Children Younger Than Five Years of Age, 1983 Through 1986

Bernard Ewigman MD, MSPH1, Coleen Kivlahan MD, MSPH2, and Garland Land MPH3

1 From the Department of Family and Community Medicine, University of Missouri-Columbia
2 From the Missouri Department of Social Services, Jefferson City
3 From the Division of Health Resources, Missouri Department of Health, Jefferson City

Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study.

Key Words: infant mortality • child abuse • homicide • violence • wounds and injuries • preschool child • mortality • cause of death • bias (epidemiology)

Submitted on July 3, 1992
Accepted on July 24, 1992




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