Citation

Tursz A, Crost M, Gerbouin-Rérolle P, Cook JM. Child Abuse Negl. 2010; ePub(ePub): ePub.

Affiliation

Inserm U750, Centre de Recherche Médecine, Sciences, Sante et Societe, Institut National de la Sante et de la Recherche Medicale (Inserm) (National Institute of Health and Medical Research), Villejuif, France.

Copyright

(Copyright © 2010, Elsevier Publishing)

DOI

10.1016/j.chiabu.2009.12.005

PMID

20684844

Abstract

OBJECTIVES: 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. PRACTICE IMPLICATIONS: 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.

Language: en