Severe Child Injury Investigation and Review

Fatal and severe child injuries have similar physical and social patterns and many more children are injured than die. If hospitalization is chosen as a definition of severity there is an exponential increase in the number of victims. The review of fatalities is functional but arbitrary. Two children with similar injuries may differ only in the fact of death. We work together on the death and leave the nonfatal severe injury to one or two professions to manage in isolation. We can do better.

Children with severe intentional injuries may be treated on sophisticated intensive care medical specialty services and burn programs and later in various rehabilitation programs. These special services can be isolated within medical systems. They lack the multiple agency connections of hospital emergency departments that report child abuse. Special programs for child HIV miss child sexual abuse found with HIV in child sexual abuse programs (Gellert Durfee, 1993). An unpublished survey of child burn services in North America (Garcia, Durfee 1995) found few protocols for reporting child abuse.

Review of nonfatal child injury may be the major new issue facing child death review teams. Limiting intake to hospitalized children will make intake more manageable. Age and the type of injury, e.g., head trauma, can limit intake again. More children will be brought to child protection. Hospitals and health systems will be more involved with case management. The potential for increased protection of children is enormous.

Rochester County, New York, developed a process years ago with multi-agency review that included all deaths in five counties and all children hospitalized in intensive care. Even though the Rochester program ended with a change in staff, it did demonstrate a model created with existing resources. A survey by the American Bar Association augmented by ICAN NCFR now includes nine states with some review of nonfatal review. This survey will be updated; the process defined and teams with nonfatal review connected in 2005. Send your material on nonfatal review to michaeld55@aol.com.

ABA Survey. Minnesota added by ICAN NCFR from their report.

• Maine Child Death and Serious Injury Review Panel
Team was established in 1992 and includes near fatality cases in their reports.
• Maryland Child Death Review Program
Team reviews “near fatalities”
• Minnesota Child Mortality Review Panel
In 1998, a statute required the panel to review near-fatal injuries due to maltreatment or suspected maltreatment. According to the panel’s finding report, the Minnesota Department of Human Services was informed of two non-fatal injury cases. The department plans to work with counties to improve reporting and conducting local child mortality reviews on near fatal injuries that result from child maltreatment.
• New Jersey Child Fatality and Near Fatality Review Board
Team reviews “near fatality” cases.
• New York
Team reviews “near fatalities” resulting from child abuse and neglect.
• Oklahoma Child Death Review Board
Team reviews “near fatalities” and has a process for review of near death cases resulting from child abuse or neglect.
• Rhode Island Child Death and Injury Review Team
Team reviews critical injury cases.
• South Dakota Regional Infant & Child Mortality Review Committee
Team reviews “near fatality” cases.
• Wyoming Child Major Injury/Fatality Review Team
The team expanded in 1999 to include reviews of “near fatalities” and major injuries to children who at time of injury were in child welfare agency custody. From their annual reports, the team reviewed 9 cases in 1999, 4 cases in 2000, 1 case in 2001, and 6 cases in 2002 that involve major injuries.

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