title: Underascertainment of child maltreatment fatalities by death certificates, 1990-1998.
abstract: OBJECTIVE
  Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment.
  
  
  METHODS
  We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression.
  
  
  RESULTS
  Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52-21.55) more likely to be ascertained than maltreatment by a parent.
  
  
  CONCLUSIONS
  The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups.
authors.affiliation: Colorado Department of Public Health and Environment, Denver, Colorado 80246-1530, USA. tessa.crume@state.co.us
authors.forename: Tessa L
authors.initials: TL
authors.lastname: Crume
authors.forename: Carolyn
authors.initials: C
authors.lastname: DiGuiseppi
authors.forename: Tim
authors.initials: T
authors.lastname: Byers
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Sirotnak
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Garrett
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002649:Child Abuse / Q000401:mortality*; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D003644:Death Certificates; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D012959:Socioeconomic Factors; D014481:United States