Investigation and Review of Unexpected Infant and Child Deaths

PEDIATRICS ◽  
1993 ◽  
Vol 92 (5) ◽  
pp. 734-735
Author(s):  
Keyword(s):  
Public Health ◽  
United States ◽  
Child Abuse ◽  
Child Death ◽  
Significant Proportion ◽  
The United States ◽  
Medical Examiner ◽  
Sudden Infant ◽  
Child Deaths ◽  
Death Investigation

A significant proportion of infant and child deaths are preventable. Of the 55 861 deaths of children aged 14 and younger in the United States in 1989, more than three fourths occurred in children under the age of 2 years.1 Approximately one third of the latter were unexpected, including those due to sudden infant death syndrome (SIDS) or trauma, or deaths that were otherwise unexplained. Child abuse deaths occur in greatest numbers among infants, followed by those in toddlers and preschool children.2 Children younger than 6 years of age are most vulnerable to abuse because of their small size, incomplete verbal skills, and often limited contact with adults other than their primary caretakers.3 With few exceptions, throughout the United States there is no uniform system for the investigation of infant and child deaths. Many jurisdictions lack appropriately trained pathologists, interagency collaboration hat would facilitate sharing of information about the family, and a surveillance system to evaluate data regarding infant deaths. As a result, progress in the understanding of SIDS is inhibited, cases of child abuse and neglect may be missed, familial genetic diseases go undiagnosed, public health threats may be unrecognized, and inadequate medical care may be undetected. Lack of adequate infant and child death investigation is an impediment to preventing illness, injury and death of other children at risk. Adequate death investigation requires the participation of numerous individuals including medical examiner/coroner, public health officials, the patient's physician, the pathologist, and personnel from agencies involved with child welfare and social services and law enforcement.

Medical Examiners, Coroners, and Public Health: A Review and Update

2006 ◽  
Vol 130 (9) ◽  
pp. 1274-1282 ◽  
Author(s):  
Randy Hanzlick
Keyword(s):  
Public Health ◽  
Criminal Justice ◽  
The United States ◽  
Background Information ◽  
Medical Examiner ◽  
Epidemiologic Research ◽  
The Public ◽  
Death Investigation ◽  
Medical Examiners

Abstract Context.—Traditionally, the emphasis of work done by medical examiners, coroners, and the death investigation community has been viewed as serving the criminal justice system. During the last several decades, however, an important role for these 3 groups has emerged within public health. Objective.—To provide important background information on death investigation systems, the evolution and framework of public health entities that rely on information gathered by medical examiners and coroners, and the role of medical examiners and coroners in epidemiologic research, surveillance, and existing public health programs and activities. Data Sources.—Previous articles on epidemiologic aspects of forensic pathology and the role of medical examiners and coroners in epidemiologic research and surveillance; a review of the Web sites of public health and safety agencies, organizations, and programs that rely on medical examiner and coroner data collected during medicolegal investigations; and a review of recent public health reports and other publications of relevance to medical examiner and coroner activities. Conclusions.—The role of medical examiners and coroners has evolved from a criminal justice service focus to a broader involvement that now significantly benefits the public safety, medical, and public health communities. It is foreseeable that the public health role of medical examiners and coroners may continue to grow and that, perhaps in the not-too-distant future, public health impact will surpass criminal justice as the major focus of medicolegal death investigation in the United States.

scholarly journals Drug Overdose Surveillance and Information Sharing via a Public Database: The Role of the Medical Examiner/Coroner

2017 ◽  
Vol 7 (1) ◽  
pp. 60-72 ◽  
Author(s):  
Karl E. Williams ◽  
Michael D. Freeman ◽  
Lynn Mirigian
Keyword(s):  
Public Health ◽  
United States ◽  
Information Dissemination ◽  
National Level ◽  
The United States ◽  
Public Access ◽  
Medical Examiner ◽  
Health Crisis ◽  
Death Scene ◽  
Drug Death

The medical examiner/coroner (ME/C) death scene investigation systems of the United States play a pivotal role in the current public health crisis created by the expanding drug dependency epidemic in the United States. The first point of recognition of a drug-related death in a community is often the local ME/C agency. This circumstance places these entities in an ideal position to provide surveillance data regarding the epidemiology of drug-related deaths occurring within the jurisdiction of the agency. The ability to surveil for the distribution and determinants among drug-related deaths at the first point of contact enhances the capacity to recognize actionable trends at the local, state, and national levels, including the ability to identify secular (longer-term) trends among various drugs and population subgroups, as well as activity spikes (outbreaks) associated with high-potency formulations and drug combinations. In this article, we describe the development and implementation of an online website that provides public access to a wide array of drug-related death surveillance resources and tools. The website gives users access to a detailed dataset that includes information regarding specific drugs, demographic information pertaining to the decedent, and to investigational findings related to the circumstances of the death. A unique aspect of the database is that it is populated by ME/C agencies and accessed by the public with no intermediary agency, so that the lag time between the identification and investigation of the death as drug-related and community knowledge of the circumstances of the death is minimized. Wide dissemination of accurate drug death surveillance information in an easily accessible and customizable format promotes societal awareness of the drug death epidemic, but also provides information to public health, law enforcement, regulatory, and other community-based organizations that can benefit from the most up-to-date knowledge. We envision a national system of surveillance at the regional ME/C level that would allow for optimal information dissemination and sharing. Such a system would likely allow for more efficacious allocation of resources at the regional and national level.

Estimates of Fatal Child Abuse and Neglect, United States, 1979 Through 1988

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 338-343 ◽  
Author(s):  
Philip W. McClain ◽  
Jeffrey J. Sacks ◽  
Robert G. Froehlke ◽  
Bernard G. Ewigman
Keyword(s):  
United States ◽  
Child Abuse ◽  
Child Abuse And Neglect ◽  
Sudden Infant Death ◽  
The United States ◽  
Case Definition ◽  
Sudden Infant ◽  
Coding System ◽  
Accidental Injury ◽  
Abuse And Neglect

The results of recent surveys in the United States have suggested a rising tide of fatalities due to child abuse or neglect (CAN). Because these surveys lack consistency in case definition and are incomplete in coverage, the use of death certificate data to estimate the number of CAN deaths was explored. To estimate these deaths among children 0 through 17 years old for 1979 through 1988, three models were formulated, each comprising six coding categories: (1) deaths coded explicitly as due to CAN, (2) homicides, (3) injury deaths of undetermined intentionality, (4) accidental injury deaths, (5) sudden infant death syndrome fatalities, and (6) natural-cause deaths. Research studies and crime data were relied on to estimate the proportions of deaths in categories 2 through 6 that were actually due to CAN, and other assumptions were varied to create a range of estimates. For the 10-year period, the estimated mean annual CAN fatalities ranged from 861 to 1814 for ages 0 through 4, and from 949 to 2022 for ages 0 through 17. Child abuse and neglect death rates did not increase over the period; in fact, they were relatively stable for ages 0 through 17 and showed a modest decline for 0 through 4. Ninety percent of fatal CAN occurs among children younger than 5 years old, and 41% occurs among infants. About 85% of CAN deaths are recorded as due to other causes. It is concluded that the magnitude of fatal CAN can be estimated from death certificates. It is recommended that the death coding system be modified to make CAN identification easier and that this study's methodology be refined to provide the basis for ongoing surveillance.

Can increases in Twitter posts predict increases in cumulative incidence of COVID-19 in the United States? Evidence that social media can inform epidemic surveillance. (Preprint)

2020 ◽  
Author(s):  
Ruoyan Sun ◽  
Henna Budhwani
Keyword(s):  
Public Health ◽  
United States ◽  
Cumulative Incidence ◽  
Hot Spots ◽  
Adult Population ◽  
State Level ◽  
The United States ◽  
Education Attainment ◽  
Public Health Systems ◽  
Per Capita

BACKGROUND Though public health systems are responding rapidly to the COVID-19 pandemic, outcomes from publicly available, crowd-sourced big data may assist in helping to identify hot spots, prioritize equipment allocation and staffing, while also informing health policy related to “shelter in place” and social distancing recommendations. OBJECTIVE To assess if the rising state-level prevalence of COVID-19 related posts on Twitter (tweets) is predictive of state-level cumulative COVID-19 incidence after controlling for socio-economic characteristics. METHODS We identified extracted COVID-19 related tweets from January 21st to March 7th (2020) across all 50 states (N = 7,427,057). Tweets were combined with state-level characteristics and confirmed COVID-19 cases to determine the association between public commentary and cumulative incidence. RESULTS The cumulative incidence of COVID-19 cases varied significantly across states. Ratio of tweet increase (p=0.03), number of physicians per 1,000 population (p=0.01), education attainment (p=0.006), income per capita (p = 0.002), and percentage of adult population (p=0.003) were positively associated with cumulative incidence. Ratio of tweet increase was significantly associated with the logarithmic of cumulative incidence (p=0.06) with a coefficient of 0.26. CONCLUSIONS An increase in the prevalence of state-level tweets was predictive of an increase in COVID-19 diagnoses, providing evidence that Twitter can be a valuable surveillance tool for public health.

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