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Improvements in child fatality review process needed
AAP. Pediatrics. 2010;126:592-596.
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With the help of pediatricians and specially formed teams, public health officials can better the child fatality review process and create effective strategies to fight preventable child deaths, American Academy of Pediatrics officials said in a statement last month.
“Ultimately, the purpose of child fatality review is to identify effective prevention and intervention processes to decrease preventable child deaths through systematic evaluation of individual child deaths and the personal, familial, and community conditions, policies, and behaviors that contribute to preventable deaths,” the researchers wrote in a policy statement.
Although data indicate that injury is the leading cause of death among children, fatality reviews cannot always pinpoint specific reasons for injuries, such as child maltreatment. To enhance information provided by these evaluations, the formation of child fatality review teams (CFRTs) may be essential, the AAP noted.
These teams include representatives from law enforcement, child protective services, the office of the medical examiner or coroner, the prosecuting attorney’s office, the medical community and public health or other community stakeholders.
The role of CFRTs has evolved during the past few years, according to the AAP, and now many teams not only investigate child deaths related to maltreatment but all child deaths within their jurisdictions. They have contributed to identifying causes of child mortality, such as bed-sharing with adults and improper child restraint use in motor vehicle laws, in several states. These findings prompted better legislation and even improved funding, training and policy improvements for child welfare systems.
The researchers also note that the child fatality review process, with the aid of CFRTs, can also expand interagency cooperation and discover problems in health care.
While CFRTs provide important data, little funding is channeled toward these evaluations, the researchers said. Additionally, variation in state and local review processes create inconsistencies in the quality of information.
To address these problems, the AAP notes that standardization of the review process; definitions for fatality coding and data collection; and confidentiality protocols and legal protection for CFRT members is required. Creating criteria for improvements in data collection, evaluation and dissemination are also crucial steps toward crafting better child fatality reviews.
Supplying CFRTs and public health officials with training and technical assistance for accessing and using data as well as publishing online annual reports can also help integrate the knowledge offered by the reviews, the researchers said. Additionally, establishing processes for interstate and cross-jurisdictional sharing expand opportunities for program comparison and collection of a broader spectrum of data.
Pediatricians can also play a crucial role in improving these efforts. The AAP called on health care professionals to advocate for proper death certification and comprehensive death investigations that involve autopsies and immediate evaluation of the scene.
Pediatricians should also coordinate efforts with their state AAP chapters to support state legislation requiring autopsies for all children aged younger than 6 years that result from trauma; are unexpected; are related to sudden unexplained infant death; or appear suspicious in any way. Health care providers should also advocate appropriate funding for these policies and call for national dissemination and analysis of data.
The researchers also said pediatricians should serve as expert consultants for child fatality review committees and offer their opinions on cases and medical examinations. Additionally, physicians can disseminate and advocate appropriate prevention strategies among the general population.
The AAP also recommends that public policy initiatives that are based on sound data collected through fatality reviews receive proper support and funding.