UPDATE FROM THE SC CHILD
FATALITY ADVISORY COMMITTEE
H. Gratin Smith, MD
September 11, 2013
Why Does Child Death Review
Matter?
 Helps to identify trends on a statewide scale
 Allows for comparison to other state...
An Overview
 What is the SC Child Fatality Advisory
Committee?
 What does the committee do?
 What are the recent trends...
Formation of the SC CFAC
 In 1993 legislation mandated (but did not provide
for funding of) the formation of the State Ch...
Deaths Reviewed by the SC
CFAC
 The death of any child (<18) that is
unexpected, suspicious, unexplained or
occurs when t...
Makeup of the SC CFAC
 Members are appointed by the governor after
recommendation from the specific state
agencies or the...
Members of the SC CFAC as
specified in the legislation
forming the committee
 DHEC
 DDSN
 SCDE
 SLED
 SCAAP-Pediatric...
SC CFAC Meetings
 Full day every other month
 Guest presenters
 Reports from members
 Review @ 40 cases per meeting du...
The Process of Child Death
Review
 A child death occurs
 Coroner is notified
 Coroner notifies SLED within 48 hours
 C...
What Does the CFAC Actually
Do?
 Case reports are sent to members before the
meeting
 Agencies involved report on their
...
What Does the CFAC NOT DO?
 The committee’s function is not to
investigate or solve crimes
 The goal is not to criticize...
Recent Findings of the SC CFAC
Reviews
 The cases are categorized based on the year
that they occurred.
 The most recent...
SC Statistics
 Population about 4.5 million
 Population < 18 y.o. (23%) about 1,035,000
 White citizens 66.2%
 Black c...
2009 SC Child Fatalities by
Race
81
84
13
5
2
4
White
Black
Hispanic
Biracial
Asian
Unknown
2009 SC Child Fatalities by
Gender
58%
42% male
female
Manner of Death Categories
 For every death there is an assigned cause of
death (very many) and one of 5 “manners of
deat...
2009 Manner of Child Death by
Category
0%
5%
10%
15%
20%
25%
30%
35%
40%
Accident Natural Homicide Undet Pending Suicide
Accidental Child Deaths in SC
1993-2009
0
20
40
60
80
100
120
2009 SC Accidental Child
Deaths
26
19
13
5
3 2 1
Asphyxia
Drowning
Fire
Shooting
Overdose
Vehicular
Poisoning
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.
2009 SC Accidental Child Deaths
by Gender
0
5
10
15
20
25
30
35
40
45
50
male female
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.
2009 SC Child Drowning Deaths
by Gender
0
2
4
6
8
10
12
14
Male Female
2009 SC Child Fire Deaths
by Race
75
1
Black
Other
White
2009 SC Child Fire Deaths
by Home Structure Type
Mobile
Stick Built
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
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.
In 2009, Two SC Children Died
in ATV (4 Wheeler) Accidents
SIDS/SUDI/SUID Cases in SC
1993-2009
0
10
20
30
40
50
60
70
80
1993-2009 Child Homicide Deaths
in SC
0
5
10
15
20
25
30
35
40
45
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
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
St...
2009 SC Fatal Child Abuse and
Neglect by Category
4
2
8
1
1
AbusHdTr
Asphyxia
Beating
HeadTr
Malnutrit
Some SC Counties With High
Numbers of Child Fatalities 2009
(#), rate (#/100,000)
 Sptnbrg (26) 35
 Richland (21) 24
 A...
2009 SC Child Suicides, # 8
 Males #4
 Females #4
 10-14 y.o. #2
 15-17 y.o. #6
 Shooting #2
 Hanging #6
Trends Noted by the SC CFAC
 There are an alarming number of child deaths
involving 4-wheelers
 Child deaths in fires ar...
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South Carolina Child Death Fatalities

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South Carolina Child Death Fatalities

  1. 1. UPDATE FROM THE SC CHILD FATALITY ADVISORY COMMITTEE H. Gratin Smith, MD September 11, 2013
  2. 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. 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. 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. 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. 6. Makeup of the SC CFAC  Members are appointed by the governor after recommendation from the specific state agencies or the committee.
  7. 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. 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. 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. 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. 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. 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. 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. 14. 2009 SC Child Fatalities by Race 81 84 13 5 2 4 White Black Hispanic Biracial Asian Unknown
  15. 15. 2009 SC Child Fatalities by Gender 58% 42% male female
  16. 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. 17. 2009 Manner of Child Death by Category 0% 5% 10% 15% 20% 25% 30% 35% 40% Accident Natural Homicide Undet Pending Suicide
  18. 18. Accidental Child Deaths in SC 1993-2009 0 20 40 60 80 100 120
  19. 19. 2009 SC Accidental Child Deaths 26 19 13 5 3 2 1 Asphyxia Drowning Fire Shooting Overdose Vehicular Poisoning
  20. 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. 21. 2009 SC Accidental Child Deaths by Gender 0 5 10 15 20 25 30 35 40 45 50 male female
  22. 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. 23. 2009 SC Child Drowning Deaths by Gender 0 2 4 6 8 10 12 14 Male Female
  24. 24. 2009 SC Child Fire Deaths by Race 75 1 Black Other White
  25. 25. 2009 SC Child Fire Deaths by Home Structure Type Mobile Stick Built
  26. 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. 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. 28. In 2009, Two SC Children Died in ATV (4 Wheeler) Accidents
  29. 29. SIDS/SUDI/SUID Cases in SC 1993-2009 0 10 20 30 40 50 60 70 80
  30. 30. 1993-2009 Child Homicide Deaths in SC 0 5 10 15 20 25 30 35 40 45
  31. 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. 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. 33. 2009 SC Fatal Child Abuse and Neglect by Category 4 2 8 1 1 AbusHdTr Asphyxia Beating HeadTr Malnutrit
  34. 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. 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. 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

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