@article{ref1,
title="Underascertainment of child abuse fatalities in France: Retrospective analysis of judicial data to assess underreporting of infant homicides in mortality statistics",
journal="Child abuse and neglect",
year="2010",
author="Tursz, Anne and Crost, M. and Gerbouin-Rérolle, P. and Cook, J. M.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVES: Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. METHODS: A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996-2000, with follow-up of their files until case closing (1996-2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics. RESULTS: We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome SIDS without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2-3.6 times higher than those in mortality statistics. Nearly 1/3 of &quot;accidental&quot; deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians' inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department. CONCLUSIONS: In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics. PRACTICE IMPLICATIONS: This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician &quot;training&quot; section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification.<p /> <p>Language: en</p>",
language="en",
issn="0145-2134",
doi="10.1016/j.chiabu.2009.12.005",
url="http://dx.doi.org/10.1016/j.chiabu.2009.12.005"
}