Underascertainment of child abuse fatalities in France: retrospective analysis of judicial data to assess underreporting of infant homicides in mortality statistics.
OBJECTIVE
Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation.


METHODS
A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996-2000, with follow-up of their files until case closing (1996-2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics.


RESULTS
We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome [SIDS] without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2-3.6 times higher than those in mortality statistics. Nearly 1/3 of "accidental" deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians' inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department.


CONCLUSIONS
In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics.


CONCLUSIONS
This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician "training" section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification.
Tursz
Anne
A
Inserm U750, Centre de Recherche Médecine, Sciences, Santé et Société, Institut National de la Santé et de la Recherche Médicale (Inserm) (National Institute of Health and Medical Research), Villejuif, France.
Crost
Monique
M
Inserm U750, Centre de Recherche Médecine, Sciences, Santé et Société, Institut National de la Santé et de la Recherche Médicale (Inserm) (National Institute of Health and Medical Research), Villejuif, France.
Gerbouin-Rérolle
Pascale
P
Inserm U750, Centre de Recherche Médecine, Sciences, Santé et Société, Institut National de la Santé et de la Recherche Médicale (Inserm) (National Institute of Health and Medical Research), Villejuif, France.
Cook
Jon M
JM
Inserm U750, Centre de Recherche Médecine, Sciences, Santé et Société, Institut National de la Santé et de la Recherche Médicale (Inserm) (National Institute of Health and Medical Research), Villejuif, France.
D000328:Adult; D002423:Cause of Death; D002649:Child Abuse / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007237:Infanticide / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D013398:Sudden Infant Death; D044465:White People