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Medical records as screening tools for child death review in Japan
Atsushi Numaguchi1,2, Akira Ishii3, Jun Natsume2,4
1Department of Emergency and Intensive Care Medicine, Nagoya University Hospital, Nagoya, Japan.
Insights
Identifying child death review (CDR) etiologies in Japan is crucial. Surveying clinical medical records (CMRs) offers a promising method for initiating the CDR process, revealing more preventable deaths than vital statistics.
Area of Science:
- Pediatric mortality analysis
- Public health surveillance
- Forensic pathology
Background:
- Optimal child death review (CDR) systems are still under development in Japan.
- Understanding the causes of child mortality is essential for improving prevention strategies.
Purpose of the Study:
- To identify the etiologies of child deaths in Japan.
- To propose an effective screening method for initiating the CDR process.
Main Methods:
- Retrospective analysis of clinical medical records (CMRs) and autopsy reports for children under 15 years (2014-2016) in Aichi Prefecture.
- Comparison of findings with vital statistics to assess discrepancies.
- Three-step data analysis approach.
Main Results:
- A significant proportion of deaths (11.5% extrinsic, 19.7% unknown) were identified.
- Suspected maltreatment cases (64) were higher than government statistics indicated.
- A substantial number of deaths (26.8%) were deemed preventable, with CMRs suggesting a higher screening rate (40.8%-47.8%) for unnatural deaths compared to vital statistics (29.2%).
Conclusions:
- Surveying clinical medical records (CMRs) is a viable method for detecting and screening child deaths for the CDR process in Japan.
- This approach may improve the identification of preventable child deaths and inform public health interventions.
Background:
Although many child death review (CDR) systems have been developed in Japan, the optimal system is still being identified. The aim of this study is to identify the etiologies of child deaths and to propose a screening method for initiating the CDR process in Japan.
Methods:
Clinical medical records (CMRs) in hospitals and autopsy records were surveyed for cases of deaths of children aged less than 15 years between 2014 and 2016 in Aichi Prefecture, Japan. The data were analyzed in three steps, and the findings were compared with the vital statistics.
Results:
Of the 695 children whose death certificates were submitted to Aichi Prefecture, 590 could be traced to pediatric care hospitals. The distribution of causes of death was slightly different from the vital statistics, with 11.5% dying of extrinsic causes and 19.7% dying of unknown causes. Maltreatment was suspected in 64 cases, which was much higher than that in government statistics. Overall, 158 (26.8%) deaths were considered preventable. The number of unnatural deaths, which might be screened in, was calculated as 172 (29.2%) in the vital statistics, whereas the survey of CMRs revealed that 241 (40.8%) to 282 (47.8%) should be screened in.
Conclusions:
Surveying CMRs in hospitals may be a suitable method to detect and screen deaths to start the CDR process in Japan.
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