Estimates of fatal child abuse and neglect, United States, 1979 through 1988.

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.(ABSTRACT TRUNCATED AT 250 WORDS)

Geographic patterns of fatal abuse or neglect in children younger than 5 years old, United States, 1979 to 1988.

OBJECTIVE: To examine geographic patterns of fatal child abuse or neglect (CAN) among children younger than 5 years old. DESIGN: A death certificate-based model to estimate the occurrence of fatal CAN. SETTING: United States, 1979 to 1988. PARTICIPANTS: The population of children younger than 5 years old. INTERVENTIONS: None. MAIN RESULTS: We estimate that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirmed CAN, and the higher is the estimate of the sum of confirmed, probable, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A threefold difference was noted between rates in the lowest- and highest-ranking states (ie, Connecticut, 2.9 to 5.2 per 100,000, and Nevada, 6.7 to 15.4 per 100,000, respectively). When the 39 largest metropolitan areas were ranked, a similar variation between the lowest and the highest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100,000, and Phoenix, Ariz, 6.6 to 15.5 per 100,000, respectively). CONCLUSION: Understanding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to that of Connecticut, between 434 and 908 fewer CAN deaths might occur annually.

A microcomputer program for coding external cause of injury.

The publication of Injury in America emphasized a renewed interest in the scientific study of trauma. Collection and analysis of population-based data were viewed as necessary prerequisites for the establishment and evaluation of injury prevention programs. While it was noted that there is an existing broad-based gathering of injury mortality information, it was also made clear that there is a paucity of systematically collected morbidity data. A fundamental step toward correcting this deficiency is to identify and adopt a uniform system for coding causes of injury morbidity that is compatible with the large body of mortality data currently being collected. This paper describes a microcomputer-based program, which is intended to aid in the selection of External Cause of Injury Codes (E-codes). It is designed for coding both fatal and nonfatal injury causes and is appropriate for use in the hospital setting. The system is a modification of the one currently used for coding all injury deaths in the United States.

Trauma registries. Current status and future prospects.

Hospital trauma registries are evolving rapidly as a result of a renewed focus on trauma care evaluation and recent advances in microcomputer technology. In theory, trauma registries can serve as the principal tool for the systematic audit of the quality of patient care provided by a hospital or a trauma system and as a potential source of part of the data needed for injury surveillance. In practice, however, there is a tendency to underestimate the resources needed to initiate and maintain a registry. Herein, we describe the purposes, resource requirements, and limitations of trauma registries. We conclude that standardization of case criteria, core data content, data definitions, and coding conventions can enhance the utility of trauma registries.

Vietnam veterans' risks for fathering babies with birth defects.

Vietnam veterans' risks for fathering babies with major structural birth defects were assessed using a case-control study. Information regarding military service in Vietnam was obtained from interviews with mothers and fathers of babies in case and control groups and from review of military records. Vietnam veterans, in general, did not have an increased risk of fathering babies with defects (all types combined; relative risk estimate, 0.97). Vietnam veterans who had greater estimated opportunities for Agent Orange exposure did not seem to be at greater risk for fathering babies with all types of defects combined. However, for a few specific types of defects the estimated risks were higher for subgroups of Vietnam veterans that may have had a greater likelihood of exposure to Agent Orange. These seemingly higher risks could be chance events, the result of some experience in the Vietnam service of the father, or the result of some other unidentified risk factor.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in emergency department record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product, Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.

Data elements for emergency department systems, release 1.0 (DEEDS): a summary report. DEEDS Writing Committee.

Variations in the way that data are entered in ED record systems impede the use of ED records for direct patient care and deter their reuse for many other legitimate purposes. To foster more uniform ED data, the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control is coordinating a public-private partnership that has developed recommended specifications for many observations, actions, instructions, conclusions, and identifiers that are entered in ED records. The partnership's initial product. Data Elements for Emergency Department Systems, Release 1.0 (DEEDS), is intended for use by individuals and organizations responsible for ED record systems. If the recommended specifications are widely adopted, then problems--such as data incompatibility and high costs of collecting, linking, and using data--can be substantially reduced. The collaborative effort that led to DEEDS, Release 1.0 sets a precedent for future review and revision of the initial recommendations.