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South Carolina Child Death Fatalities
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South Carolina Child Death Fatalities

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H. Gratin Smith, MD

H. Gratin Smith, MD

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  • 1. UPDATE FROM THE SC CHILD FATALITY ADVISORY COMMITTEE H. Gratin Smith, MD September 11, 2013
  • 2. Why Does Child Death Review Matter?  Helps to identify trends on a statewide scale  Allows for comparison to other states  Helps to make sure deaths are accurately classified to make meaningful analysis possible  Allows for more informed suggestions for change  The CDC has determined that the multidisciplinary approach now in place is the most effective way to help decrease child deaths
  • 3. An Overview  What is the SC Child Fatality Advisory Committee?  What does the committee do?  What are the recent trends and findings noted by the committee, and what are their recommendations?
  • 4. Formation of the SC CFAC  In 1993 legislation mandated (but did not provide for funding of) the formation of the State Child Fatality Advisory Committee to identify patterns in child fatalities.  An annual report is produced. This information is to be used by communities, individuals and agencies to decrease the number of preventable child deaths in our state.  The report can be viewed at SC DHEC’s website.
  • 5. Deaths Reviewed by the SC CFAC  The death of any child (<18) that is unexpected, suspicious, unexplained or occurs when the child is NOT under the direct care of a physician. This includes, but is not limited to SIDS cases.  Traffic/highway deaths are not reviewed by the SC CFAC (unless they occur on private property). They are reviewed by the DMV.
  • 6. Makeup of the SC CFAC  Members are appointed by the governor after recommendation from the specific state agencies or the committee.
  • 7. Members of the SC CFAC as specified in the legislation forming the committee  DHEC  DDSN  SCDE  SLED  SCAAP-Pediatrician  A forensic pathologist  SC Criminal Justice Academy  DSS  DYS  SC Commission on Alcohol and Drug Abuse  SC Coroner  Solicitor  SCDMH  2 Child Advocates
  • 8. SC CFAC Meetings  Full day every other month  Guest presenters  Reports from members  Review @ 40 cases per meeting during executive session (closed to public). (@ 200- 250 cases are reviewed every year)
  • 9. The Process of Child Death Review  A child death occurs  Coroner is notified  Coroner notifies SLED within 48 hours  Case is assigned to an agent  Agent gets details, medical records, DSS notes, LE notes  Case report is “completed” by the agent  Case goes to CFAC
  • 10. What Does the CFAC Actually Do?  Case reports are sent to members before the meeting  Agencies involved report on their involvement with the case  Medical aspects of the case are reviewed  The committee tries to determine how the death may have been prevented by looking at SYSTEMS ISSUES
  • 11. What Does the CFAC NOT DO?  The committee’s function is not to investigate or solve crimes  The goal is not to criticize, but to offer suggestions for improvement by analyzing system failures.
  • 12. Recent Findings of the SC CFAC Reviews  The cases are categorized based on the year that they occurred.  The most recent annual review that has been completed is 2009. There were 189 deaths in 2009 that were reviewed.  The statistics in this presentation are from cases that met the definition for review by the SCFAC (not the total number of child deaths in the state)
  • 13. SC Statistics  Population about 4.5 million  Population < 18 y.o. (23%) about 1,035,000  White citizens 66.2%  Black citizens 27.9%  17% of citizens below the poverty level  Per cent of 8th graders to graduate- 75%  @ 25% of babies born to single mothers
  • 14. 2009 SC Child Fatalities by Race 81 84 13 5 2 4 White Black Hispanic Biracial Asian Unknown
  • 15. 2009 SC Child Fatalities by Gender 58% 42% male female
  • 16. Manner of Death Categories  For every death there is an assigned cause of death (very many) and one of 5 “manners of death”  Natural  Accidental/Unintentional Injury  Homicide  Suicide  Undetermined
  • 17. 2009 Manner of Child Death by Category 0% 5% 10% 15% 20% 25% 30% 35% 40% Accident Natural Homicide Undet Pending Suicide
  • 18. Accidental Child Deaths in SC 1993-2009 0 20 40 60 80 100 120
  • 19. 2009 SC Accidental Child Deaths 26 19 13 5 3 2 1 Asphyxia Drowning Fire Shooting Overdose Vehicular Poisoning
  • 20. 2009 SC Accidental Child Deaths by Age 0 5 10 15 20 25 30 <1 y.o. 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17 y.o.
  • 21. 2009 SC Accidental Child Deaths by Gender 0 5 10 15 20 25 30 35 40 45 50 male female
  • 22. 2009 SC Child Drowning Deaths by Age 0 1 2 3 4 5 6 7 8 9 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17 y.o.
  • 23. 2009 SC Child Drowning Deaths by Gender 0 2 4 6 8 10 12 14 Male Female
  • 24. 2009 SC Child Fire Deaths by Race 75 1 Black Other White
  • 25. 2009 SC Child Fire Deaths by Home Structure Type Mobile Stick Built
  • 26. 2009 SC Child Fire Deaths by Age 0 1 2 3 4 5 6 7 8 <1 yr 1-4 yrs 5-9 yrs 10-14 yrs 15-17
  • 27. In 2009, Five SC Children Died of Accidental Gunshot Wounds 0 0.5 1 1.5 2 2.5 5-9 y.o. 10-14 y.o. 15-17 y.o.
  • 28. In 2009, Two SC Children Died in ATV (4 Wheeler) Accidents
  • 29. SIDS/SUDI/SUID Cases in SC 1993-2009 0 10 20 30 40 50 60 70 80
  • 30. 1993-2009 Child Homicide Deaths in SC 0 5 10 15 20 25 30 35 40 45
  • 31. 2009 SC Child Homicide Deaths by Age 0 2 4 6 8 10 12 14 <1 y.o. 1-4 y.o. 5-9 y.o. 10-14 y.o. 15-17
  • 32. Perpetrators of Fatal Child Abuse and Neglect in SC 2009 4 4 3 2 1 1 1 1 17 cases Mom's BF Father Stranger Uncle Mother Stepmom Sibling Other
  • 33. 2009 SC Fatal Child Abuse and Neglect by Category 4 2 8 1 1 AbusHdTr Asphyxia Beating HeadTr Malnutrit
  • 34. Some SC Counties With High Numbers of Child Fatalities 2009 (#), rate (#/100,000)  Sptnbrg (26) 35  Richland (21) 24  Anderson (5) 11.3  Beaufort (7) 21.5  York (7) 12.3  Charleston (16) 22.2  Berkley (6) 13.7  Darlington (6) 37  Greenville (14) 13  Horry (7) 13  Lexington (22) 35
  • 35. 2009 SC Child Suicides, # 8  Males #4  Females #4  10-14 y.o. #2  15-17 y.o. #6  Shooting #2  Hanging #6
  • 36. Trends Noted by the SC CFAC  There are an alarming number of child deaths involving 4-wheelers  Child deaths in fires are much more common in mobile homes  In fire death cases, the absence of functioning smoke alarms is often noted in the reports  Most sleep related deaths involve some practice recognized as an unsafe sleeping situation