Child Death Review: Evidence for National Safety Initiatives

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Child Death Review Evidence for National Safety
Initiatives

• Mary D. Overpeck, Dr.P.H.
• Manager, New Mexico Office of Injury Prevention
• Previously with
• U.S. Department of Health and Human Services
• Health Resources and Services Administration
• Maternal and Child Health Bureau

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Examples of CDR Data Uses at a National Level
2005 Omnibus Transportation Act SEC. 7258. POWER
WINDOW SWITCHES. The Secretary of Transportation
shall upgrade Federal Motor Vehicle Safety
Standard 118 to require that power windows in
motor vehicles not in excess of 10,000 pounds
have switches that raise the window only when the
switch is pulled up or out. The Secretary shall
issue a final rule implementing this section by
April 1, 2007.
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Safe Sleeping for Infants
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Why Not Use Causes Shown on U.S. Infant Death
Certificates?

• Inconsistent investigations and cause
  classification of sleep-related deaths among more
  than 2000 medical examiner and coroner systems
• Cause classification uses International
  Classification of Disease (ICD)
• ICD sleep-related death data are incomplete,
  inaccurate, and not specific enough
• Death scene reenactments are informative

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Death Scene Reenactment
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State Reviews of Sleep-Related Deaths by
Manner/Cause

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Sleep Surface Where Infant Was Foundn 1,501
from 9 States

• Bed mattress
• Crib/bassinet
• Couch/chair
• Playpen
• Waterbed
• Other places
• Dont know

• 39
• 23
• 15
• 2
• lt1
• 10
• 10

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Relationship of Caretaker at Time of Deathn
640 from 6 States
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Co-sleeping/Bedsharing?

• Almost half of 1,486 deaths in nine States
  involved co-sleeping and/or bed sharing
• No or dont know in remaining deaths
• If co-sleeping, sleeping with 1 adults?
• About 80 of co-sleeping included adults

Some information collected only for the SIDS
diagnosis and bed sharing rather than for
co-sleeping
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Multiple Risk Factors for Sleep-related
Deaths Various States Reporting

• Prone position 35 (8 States)
• Blankets/pillows/toys 30 (7 States)
• Sleeping with others 48 (9 States)

More than one factor may be present
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Conclusion Safe Sleep Evidence

• Preliminary CDR survey ? sufficient evidence that
  separated sleeping surfaces could prevent deaths
• Conference consensus ? need to address safe
  sleeping arrangements, including use of
  bassinets, cribs, or co-sleepers
• Followup survey of CDR teams will address
• Result differences based on case review criteria
• How often cribs/bassinets were available but not
  used
• Reasons available cribs/bassinets were not used
• Location of deaths when cribs/bassinets were not
  available