Defining and Identifying Near Fatal Child Maltreatment: Challenges and Opportunities

Fatal child maltreatment is a horrific but relatively rare occurrence in the United States. A larger number of children suffer from serious or nearly fatal injuries and medical conditions which are caused or contributed to by... [ view full abstract ]

Fatal child maltreatment is a horrific but relatively rare occurrence in the United States. A larger number of children suffer from serious or nearly fatal injuries and medical conditions which are caused or contributed to by child abuse or neglect. These “near fatalities” often have risk profiles similar to fatal child maltreatment, but summarizing the information and risk factors about these near fatalities across jurisdictions is hampered by the wide variation in defining and identifying them.  Near fatalities require identification and documentation by medical systems that are distinct from forensic pathology and child welfare systems typically used to identify child maltreatment.

Child Death Review Teams in the U.S. have sought to review the circumstances of near fatalities in order to better understand and identify child maltreatment.  The U.S. national Child Death Review Case Reporting System (CDR-CRS) contains detailed information on reviews in 45 states.  Approximately 1% of the cases in the database are near fatalities with most coming from only 4 U.S. states.  In another analysis of more than 3 million records in a U.S. inpatient hospital pediatric dataset, a number of factors were identified in living children that were associated with significantly higher rates of fatality among the 3% of children identified with maltreatment, 7% of whom died.  A medical diagnosis of child maltreatment nearly doubled the case fatality risk in multivariate analysis.

To assist in developing a consistent definition for child maltreatment near fatality, we will summarize U.S. program definitions, identify similarities and key attributes in large datasets, and then propose operational definitions.  We will summarize the epidemiology of near fatal injuries and conditions using several existing data sources, including findings from the CDR-CRS.  We will discuss the challenges and opportunities in conducting case reviews of these events and will propose opportunities for moving this important work forward.