Nationwide pediatric mortality: drug toxicology, unknown causes of death, and autopsy rates
Reilly, Michael P.
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Deaths among the pediatric population encompass a small percentage of the total number of fatalities across the United States. Since the deaths of infants, children, and adolescents are rare, there is little forensic literature concerning this age group. Autopsies, if performed completely, can reveal additional information surrounding circumstances of a case and leads to a determination of a cause of death or a diagnosis of exclusion. Yet studies report that nationwide autopsy rates are low, despite an increase of drugs in the environment and the prevalence of ill-defined causes of death. With the use of the Centers of Disease Control and Prevention (CDC) internet database Wide-ranging Online Data for Epidemiologic Research (WONDER), all deaths of individuals 19 years old and under were analyzed for years 2000, 2005, and 2010. The three main areas that were examined through the WONDER database were poisoning deaths for all ages, ill-defined causes of death for the infant age group, and overall autopsy rates for the three age groups with the highest crude rate of death. The crude death rate for all pediatric age groups have decreased within the examined decade. The infant age group comprised the majority of all pediatric fatalities and had the highest crude death rate. Individuals in the 15 to 19 year age group had the second highest crude death rate of the pediatric population. With a low number of total pediatric poisoning deaths, there has been a steady increase in crude death rate over the decade. The 15-19 age group encompassed the majority of these types of fatalities, with a total of 942 in 2010. It was also discovered that not every pediatric victim was autopsied when a death was diagnosed as a poisoning death when examined by a forensic pathologist. Infant ill-defined causes of death consisted of just over 12% nationwide for all years studied. However approximately 70% of all infant ill-defined causes of death were diagnosed as Sudden Infant Death Syndrome (SIDS) in 2000 and 2010. When examining autopsy rates for the year 2010, autopsies were performed for 32.9% of infant deaths, 55.1% of child deaths between 1-4 years of age, and 59.8% of teenage deaths between 15-19 years of age. In 2010, implementation of autopsies is uncertain for 2,454 deaths under 1 year, 255 deaths between 1 and 4 years, and 666 between 15 and 19 years. Measures need to be put in place nationwide to increase the rate of autopsies for the pediatric population and there needs to be strict accountability when it is not reported on a death certificate whether or not an autopsy was performed. Standard operating procedures should be applied for all autopsies of pediatric victims, with a toxicology examination always being included in an investigation.