Pediatric vehicular heatstroke: An analysis of 296 cases from the National Fatality Review Case Reporting System.

OBJECTIVES: To explore the National Fatality Review Case Reporting System (NFR-CRS) as a new data source to (1) characterize pediatric vehicular heatstroke (PVH) deaths among children <15 years of age reviewed by Child Death Review teams, and (2) identify factors independently associated with common PVH scenarios and incident locations. METHODS: Data for 2005-2019 were used to characterize 296 PVH deaths. Frequencies and percentages were calculated to describe child, supervisor, and incident characteristics. Multiple logistic regression with and without imputation were carried out to identify factors associated with the two outcomes of interest: PVH scenario (left in vehicle vs. gained access) and incident place (supervisor workplace vs. other locations). Odds ratios and 95% confidence intervals (OR, 95% CI) were calculated. RESULTS: Most children had been left unattended in vehicles (N = 225, 76.0%) and 13.5% (N = 40) had gained access independently. Children were most often male (N = 168, 56.8%), non-Hispanic White (N = 131, 44.3%), and <2 years of age (N = 172, 58.1%). Disability or chronic illness was noted for 4.7% (N = 14), 13.9% (N = 41) had a history of maltreatment, and 6.1% (N = 18) an open CPS case at the time of incident. Children left unattended were more likely to be <2 years of age (adjusted imputed OR 26.7, CI 7.3-97.2) and less likely to have an open CPS case (0.2, 0.0-0.4) and for the incident to occur at home (0.2, 0.1-0.9) compared to children who gained access. PVH deaths occurring at the supervisor's workplace were more likely to be <2 years of age (6.2, 2.4-15.8), to have occurred on a weekday (5.9, 1.7-20.9), and to have been supervised by their parent at the incident time (2.7, 1.1-6.7) compared to other locations. CONCLUSIONS: The results align with previous PVH findings and added new information on child race/ethnicity, CPS action, disability/chronic illness, and maltreatment. With the exception of parents being more likely to be the supervisor in incidents occurring at home, which was expected, neither supervisor characteristics nor child race/ethnicity or sex were independently significant in multiple regression, suggesting that PVH is pervasive and that education campaigns should be similarly broad.

Firearm Deaths among Youth in the United States, 2007-2016.

We sought to compare risk factors contributing to unintentional, homicide, and suicide firearm deaths in children. We conducted a retrospective review of the National Fatality Review Case Reporting System. We included all firearm deaths among children aged 0-18 years occurring from 2007 to 2016. Descriptive analyses were performed on demographic, psychosocial, and firearm characteristics and their relationship to unintentional, homicide, and suicide deaths. Regression analyses were used to compare factors contributing to unintentional vs. intentional deaths. There were 6148 firearm deaths during the study period. The mean age was 14 years (SD ± 4 years), of which 81% were male and 41% were non-Hispanic White. The most common manners of death were homicide (57%), suicide (36%), and unintentional (7%). Over one-third of firearms were stored unlocked. Homicide deaths had a higher likelihood of occurring outside of the home setting (aOR 3.2, 95% CI 2.4-4.4) compared with unintentional deaths. Suicide deaths had a higher likelihood of occurring in homes with firearms that were stored locked (aOR 4.2, 95% CI 2.1-8.9) compared with unintentional deaths. Each manner of firearm death presents a unique set of psychosocial circumstances and challenges for preventive strategies. Unsafe firearm storage practices remain a central theme in contributing to the increased risk of youth firearm deaths.

The COVID-19 Pandemic and Youth Suicide: 2020-2021.

BACKGROUND AND OBJECTIVES: Suicide is a leading cause of death among youth in the United States. The coronavirus disease 2019 (COVID-19) pandemic raised concerns that suicide rates will increase. The National Fatality Review-Case Reporting System documents circumstances of child deaths reviewed by multidisciplinary teams. In April 2021, a question asking whether COVID-19 directly or indirectly impacted the child's death was added to the National Fatality Review-Case Reporting System. The objective of this study was to identify factors related to suicide deaths among youth during the COVID-19 pandemic. METHODS: This exploratory study of youth aged 10 to 17 years occurring during 2020 to 2021 compared demographic and incident characteristics, life stressors, social/mental health histories, and pandemic-related disruptions to school, health, and mental health for COVID-19-impacted suicides and non-COVID-19-impacted suicides using descriptive statistics. χ2 statistics assessed statistical significance in differences across the 2 groups. RESULTS: A total of 552 suicides were included for study. Higher proportions of COVID-19-impacted suicides (n = 144) were by hanging (51% vs 40%) and occurred in suburban areas (57% vs 45%) compared with non-COVID-19-impacted suicides (n = 408). COVID-19-impacted youth also experienced significantly more isolation (60% vs 14%), school problems (42% vs 19%), depression (43% vs 24%), and/or anxiety disorder (23% vs 12%) diagnoses. CONCLUSIONS: A subset of youth experienced significant effects of the pandemic and associated measures implemented to mitigate the spread of COVID-19. They were proportionally more likely to experience isolation, school and mental health care disruptions, behavior changes, and severe emotional distress; all signs of increased risk for suicide.

Social and Demographic Characteristics and the Contribution of Fireplay to Fire-Related Mortality Among Children in the U.S., 2004-2016.

INTRODUCTION: This study seeks to describe the circumstances of fire deaths among children, identify deaths related to fireplay, and compare children whose deaths were related to fireplay with non-fireplay-related deaths. METHODS: Children aged 1-14 years who died in a fire during 2004-2016 were identified from the National Fatality Review Case Reporting System. Social, demographic, and fire characteristics were described and then compared for children who died in fires caused by fireplay versus non-fireplay-related deaths. Unadjusted ORs and 95% CIs were calculated. Data were collected 2004-2018 and analyzed in 2019. RESULTS: A total of 1,479 children who died in fires were identified. They were predominantly male (54%) and White (47%); 34% were Black. Two or more children died in 54% of incidents. Fires occurred most frequently in single-family homes (52%) and rental properties (37%); 23% were started by smoking materials or candles. Smoke alarm information was largely missing (42%) and noted to be present and working for only 82 deaths. Fireplay was responsible for 175 (12%) of the deaths. Compared with non-fireplay-related deaths, children who died in fireplay fires were more likely to be aged 1-4 years (OR=2.6, 95% CI=1.5, 4.3), male (OR=1.6, 95% CI=1.2, 2.2), have supervision documented as no, but needed (OR=8.8, 95% CI=4.1, 18.8), and have an open Child Protective Services case (OR=1.8, 95% CI=1.1, 3.0). CONCLUSIONS: This study provides data on supervision and the role of fireplay in fatal fires among young children, offering information for the development of innovative primary prevention strategies and future research.

Epidemiology of Sudden Death in a Population-Based Study of Infants and Children.

OBJECTIVE: To describe epidemiologic data from the Sudden Death in the Young (SDY) Case Registry. Understanding the scope of SDY may optimize prevention efforts. STUDY DESIGN: We analyzed sudden, unexpected deaths of infants (<365 days) and children (1-17 years) from a population-based registry of 8 states/jurisdictions in 2015 and 9 in 2016. Natural deaths and injury deaths from drowning, motor vehicle accident drivers, and infant suffocation were included; other injury deaths, homicide, suicide, intentional overdose, and terminal illness were excluded. Cases were categorized using a standardized algorithm. Descriptive statistics were used to characterize deaths, and mortality rates were calculated. RESULTS: Of 1319 cases identified, 92% had an autopsy. We removed incomplete cases, leaving 1132 analyzable deaths (889 infants, 243 children). The SDY rate for infants was 120/100 000 live births and for children was 1.9/100 000 children. Explained Cardiac rates were greater for infants (2.7/100 000 live births) than children (0.3/100 000 children). The pediatric Sudden Unexpected Death in Epilepsy (SUDEP) mortality rate was 0.2/100 000 live births and children. Blacks comprised 42% of infant and 43% of child deaths but only 23% of the population. In all ages, myocarditis/endocarditis was the most common Explained Cardiac cause; respiratory illness was the most common Explained Other cause. SDY occurred during activity in 13% of childhood cases. CONCLUSIONS: Prevention strategies include optimizing identification and treatment of respiratory and cardiac diseases.

U-Shaped Pillows and Sleep-Related Infant Deaths, United States, 2004-2015.

OBJECTIVES: To describe infant deaths where a u-shaped pillow was under or around an infant and to describe cases classified as Explained Suffocation. METHODS: We examined demographics and circumstances of 141 infant deaths during 2004-2015 in the US National Fatality Review Case Reporting System with u-shaped pillows in the sleep environment. RESULTS: Most infants were < 6 months old (92%), male (58%), non-Hispanic White (53%), and of the nine explained suffocation deaths, four occurred when the u-shaped pillow obstructed the infant's airway; five occurred when the infant rolled off the pillow and their airway was obstructed by another object. CONCLUSIONS FOR PRACTICE: Although infrequent, infant deaths with u-shaped pillows have occurred. Health care providers may include discussion of the importance of caregivers following infant product packaging precautions and warning labels for commonly used consumer products, such as u-shaped pillows in their advice to caregivers.

Firearm suicide among youth in the United States, 2004-2015.

Suicide is a leading cause of death among children in the United States; firearms cause 37% of these deaths. Research is needed to better understand firearm accessibility among youth at risk for suicide. We reviewed data from the National Fatality Review Case Reporting System (NFR-CRS). Firearm suicide deaths of children ages 10-18 occurring 2004 through 2015 with completed suicide-specific section were included. Children who had talked about, threatened or attempted suicide were identified as "Greater Risk" (GR). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Of the 2106 firearm suicide deaths, 1388 (66%) had a completed NFR-CRS suicide section. Of these, 36% (494/1388) met the criteria for GR. Firearms were less likely to be stored in a locked location for GR children [adjusted OR 0.62, (95%CI 0.49-0.98)]. Strategies to limit firearm access, particularly for GR youth, should be a focus of suicide prevention efforts.

The Sudden Death in the Young Case Registry: Collaborating to Understand and Reduce Mortality.

Knowledge gaps persist about the incidence of and risk factors for sudden death in the young (SDY). The SDY Case Registry is a collaborative effort between the National Institutes of Health, the Centers for Disease Control and Prevention, and the Michigan Public Health Institute. Its goals are to: (1) describe the incidence of SDY in the United States by using population-based surveillance; (2) compile data from SDY cases to create a resource of information and DNA samples for research; (3) encourage standardized approaches to investigation, autopsy, and categorization of SDY cases; (4) develop partnerships between local, state, and federal stakeholders toward a common goal of understanding and preventing SDY; and (5) support families who have lost loved ones to SDY by providing resources on bereavement and medical evaluation of surviving family members. Built on existing Child Death Review programs and as an expansion of the Sudden Unexpected Infant Death Case Registry, the SDY Case Registry achieves its goals by identifying SDY cases, providing guidance to medical examiners/coroners in conducting comprehensive autopsies, evaluating cases through child death review and an advanced review by clinical specialists, and classifying cases according to a standardized algorithm. The SDY Case Registry also includes a process to obtain informed consent from next-of-kin to save DNA for research, banking, and, in some cases, diagnostic genetic testing. The SDY Case Registry will provide valuable incidence data and will enhance understanding of the characteristics of SDY cases to inform the development of targeted prevention efforts.

Paediatric suicide in the USA: analysis of the National Child Death Case Reporting System.

IMPORTANCE: Suicide is a leading cause of death among youths. The relationship between mental health, psychosocial factors and youth suicidality needs further analysis. OBJECTIVE: To describe paediatric suicide in the USA and the impact of mental health and substance abuse using the National Child Death Review Case Reporting System (CDR-CRS). To identify psychosocial correlates contributing to suicide and whether these factors are more common among individuals with history of mental illness or substance abuse. DESIGN: Deidentified data (CDR-CRS) from 2004 to 2012 was obtained from 29 participating states. Demographic data and psychosocial correlates, including age, gender, cause of death, history of mental illness and/or substance abuse, school concerns, previous suicide attempts and family history of suicide, were collected. RESULTS: A total of 2850 suicides were identified. Mean age was 15.6±1.9 years; (range 7-21 years) 73.6% male and 65.1% Caucasian. The leading causes of death were asphyxia (50.2%) and weapon/firearm (36.5%). Among all subjects, 25.5% had history of mental illness and 19.0% had history of substance abuse. 60.0% had no report of mental illness or substance abuse. Subjects with both mental illness and substance abuse were more likely to have school concerns (OR=4.1 (p<0.001)), previous suicide attempts (OR=4.2 (p<0.001)) and a family history of suicide (OR=3.2 (p<0.001)) compared with subjects without those characteristics. CONCLUSIONS: Most suicide records in the CDR-CRS had no indication of mental illness or substance abuse. The youth with mental-illness/substance-abuse issues were more likely to have other compounding psychosocial correlates that may be warning signs of suicide.

Cause-specific mortality among children and young adults with epilepsy: Results from the U.S. National Child Death Review Case Reporting System.

We investigated causes of death in children and young adults with epilepsy by using data from the U.S. National Child Death Review Case Reporting System (NCDR-CRS), a passive surveillance system composed of comprehensive information related to deaths reviewed by local child death review teams. Information on a total of 48,697 deaths in children and young adults 28days to 24years of age, including 551 deaths with epilepsy and 48,146 deaths without epilepsy, was collected from 2004 through 2012 in 32 states. In a proportionate mortality analysis by official manner of death, decedents with epilepsy had a significantly higher percentage of natural deaths but significantly lower percentages of deaths due to accidents, homicide, and undetermined causes compared with persons without epilepsy. With respect to underlying causes of death, decedents with epilepsy had significantly higher percentages of deaths due to drowning and most medical conditions including pneumonia and congenital anomalies but lower percentages of deaths due to asphyxia, weapon use, and unknown causes compared with decedents without epilepsy. The increased percentages of deaths due to pneumonia and drowning in children and young adults with epilepsy suggest preventive interventions including immunization and better instruction and monitoring before or during swimming. State-specific and national population-based mortality studies of children and young adults with epilepsy are recommended.

Cardiovascular deaths in children: general overview from the National Center for the Review and Prevention of Child Deaths.

BACKGROUND: Cardiovascular conditions rank sixth in causes of death in 1- to 19-year-olds. Our study is the first analysis of the cardiovascular death data set from the National Center for the Review and Prevention of Child Deaths, which provides the only systematic collection of cardiovascular deaths in children. METHODS: We developed an analytical data set from the National Center for the Review and Prevention of Child Deaths database for cardiovascular deaths in children 0 to 21 years old, reviewing 1,098 cases from 2005 to 2009 in 16 states who agreed to participate. RESULTS: Cardiovascular cases were aged 4.8 ± 6.6 years; 55.3%, ≤1 year; 24.6%, ≥10 years; male, 58%; white, 70.5%; black, 22.3%; Hispanic, 19.5%. Prior conditions were present in 48.5%: congenital heart disease, 23%; cardiomyopathies, 4.6%; arrhythmia, 1.7%; and congestive heart failure, 1.6%. Deaths occurred most frequently in urban settings, 49.2%; and in the hospital, 40.4%; home, 26.1%; or at school/work/sports, 4.8%. Emergency medical services were not evenly distributed with differences by age, race, ethnicity, and area. Autopsies (40.4%) occurred more often in those >10 years old (odds ratio [OR] 2.9), blacks (OR 1.6), or in those who died at school/work/sports (OR 3.9). The most common cardiovascular causes of death included congenital heart disease, 40.8%; arrhythmias, 27.1%; cardiomyopathy, 11.8%; myocarditis, 4.6%; congestive heart failure, 3.6%; and coronary artery anomalies, 2.2%. CONCLUSIONS: Our study identified differences in causes and frequencies of cardiovascular deaths by age, race, and ethnicity. Prevention of death may be impacted by knowledge of prior conditions, emergency plans, automated external defibrillator programs, bystander cardiopulmonary resuscitation education, and by a registry for all cardiovascular deaths in children.

Development of a data set of national cardiovascular deaths in the young.

BACKGROUND: The only systematic collection of cardiovascular (CV) deaths in children resides in the database derived from the Case Reporting System of the National Center for the Review and Prevention of Child Deaths (NCRPCD). We describe the process used to develop an analytical data set to inform our understanding of CV deaths in children from this database. METHODS: Twenty-five states reporting natural CV deaths during 2005 to 2009 were contacted. Sixteen states agreed to participate. Cases experienced a natural CV death and were 0 to 21 years. Challenges to building a final analytical data set were identified and included reclassification, recategorization, and the development of new variables from existing data, including an algorithm to identify sudden cardiac deaths. RESULTS: The final data set included 1,098 cases. Missing data comprised a mean of 41.7% for most key variables. Cardiovascular cases were aged 4.8 ± 6.6 years; 55.3%, ≤1 year, 24.6%, ≥10 years; male, 58%; white, 70.5%; black, 22.3%; and Hispanic, 19.5%. CONCLUSIONS: This manuscript provides the first description of the natural CV death data set from the NCRPCD. We identify potential beneficial changes in the NCRPCD Case Reporting System and review process. Analysis of these data will help determine characteristics of CV deaths and allow the assessment of risk factors that can be used to prevent CV death in the young. The rate of CV death can be lowered using knowledge of associations that can be gleaned from this robust database. Best practices for prevention hold promise for a future with fewer deaths that will need to be reviewed.

Sudden unexpected infant deaths: sleep environment and circumstances.

OBJECTIVES: We sought to describe the characteristics and sleep circumstances of infants who die suddenly and unexpectedly and to examine similarities and differences in risk factors among infants whose deaths are classified as resulting from sudden infant death syndrome (SIDS), suffocation, or undetermined causes. METHODS: We used 2005 to 2008 data from 9 US states to assess 3136 sleep-related sudden unexpected infant deaths (SUIDs). RESULTS: Only 25% of infants were sleeping in a crib or on their back when found; 70% were on a surface not intended for infant sleep (e.g., adult bed). Importantly, 64% of infants were sharing a sleep surface, and almost half of these infants were sleeping with an adult. Infants whose deaths were classified as suffocation or undetermined cause were significantly more likely than were infants whose deaths were classified as SIDS to be found on a surface not intended for infant sleep and to be sharing that sleep surface. CONCLUSIONS: We identified modifiable sleep environment risk factors in a large proportion of the SUIDs assessed in this study. Our results make an important contribution to the mounting evidence that sleep environment hazards contribute to SUIDs.