PEDIATRICS Vol. 102 No. 4 October 1998, pp. 1000-1001
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To the Editor.
It was with great concern that I read the annual summary of vital statistics.1 The 1996 mortality statistics from the National Center for Health Statistics, which are summarized from death certificate data, are presented without any commentary on the accuracy of death certificates in assigning cause of death. A clear impression is received from reviewing this article that child abuse is not an important cause of death in infancy; homicide does not crack the top ten causes of death for infants. However, even a brief review of the child fatality literature indicates the unreliability of death certificates in distinguishing homicide from accidental injury and sudden infant death syndrome (SIDS).
As early as 1993, a Centers for Disease Control and Prevention
(CDC)-sponsored report2 concluded that death certificates were an uncertain source of data on child maltreatment fatalities. They
recommended that the death coding system should be modified to make
identification of child abuse and neglect fatalities easier. These