Data serve as the foundation of all aspects of science and medicine. As clinicians, we aim to be evidence-based in our practices, because the evidence leads to improved clinical outcomes. However, evidence-based practice is reliant upon the availability and quality of the data.
This is particularly true for injury prevention. By analyzing the circumstances surrounding often tragic incidents, including nonfatal injuries and deaths, we can better understand how these injuries and deaths occur, and what might be done to prevent these in the future. This type of research can ultimately save lives and lead to better clinical outcomes.
The Child Death Review (CDR) and fetal and infant mortality review (FIMR) processes are built upon this premise: Multidisciplinary reviews of individual deaths lead to community action that prevent future injuries and fatalities.1 All of this helps to improve health outcomes. Data from CDR and FIMR have been instrumental in development of policies, safety guidelines, and protocols that have had widespread impact. After analysis of CDR data demonstrated differential sleep risks for younger and older infants,2 the American Academy of Pediatrics reinforced the need to eliminate soft bedding for infants who can roll into the prone position and may experience accidental suffocation if they roll into soft bedding.3 In another example, between 2014 and 2017, the youth suicide rate in Tennessee more than doubled to 3.4 per 100 000. To address the growing concern, the state CDR team recommended tracking youth suicide attempts to allow for real time identification of youth at risk. The Tennessee Department of Health fulfilled this recommendation by creating an algorithm to identify self-harm–related emergency department visits.4 These notifications were used to rapidly notify suicide prevention networks and coordinated school health staff to increase suicide prevention training and resources in areas experiencing suicide attempts.
This Pediatrics supplement contains 17 articles, several demonstrating how CDR and FIMR data have already been used in communities to improve health outcomes and others providing new data to support new interventions, policies, and guidelines.
The National Center for Fatality Review and Prevention (National Center) provides technical support and maintains the National Fatality Review-Case Reporting System, which is used by CDR and FIMR programs in the United States to report circumstances of these deaths in a centralized database. The National Center is working to make these data from CDR and FIMR teams available in an easy-to-use, interactive data visualization environment such as Tableau. This would allow easy access to the unique types of data collected by CDR and FIMR teams. These dashboards will allow users to set filter parameters such as cause or manner of death, age, race, ethnicity, cause-specific risk factors, or year of death.
How can data from the CDR and FIMR help you, whether you are a pediatrician or other clinician?
First, get involved with your local or state CDR and/or FIMR team. They want and need pediatricians and other clinicians to become involved. You can either contact the National Center directly ([email protected]) or reach out to your state CDR or FIMR coordinator (www.ncfrp.org/cdr-map or www.ncfrp.org/fimr-map). When you attend these multidisciplinary team meetings, you will become much more aware of factors that may contribute to deaths and can then advocate for safety on a local, state, and national level.
Second, become familiar with the child fatality data in your local area. Many local CDR and FIMR teams publish annual reports on the frequency and circumstances of fatal injuries of children. These data will help you counsel families more effectively. For instance, if you know that, in your area, there have recently been 10 drowning fatalities, and most of these involved toddlers who accessed a pool through a back door of the home, you can more specifically counsel your families about the importance of 4-sided fencing around residential pools. Your counseling will be more powerful when you mention that these deaths occurred within the community.
Third, use these data to help you advocate for safety. You can start locally with quality improvement (QI) projects. In fact, to support pediatrician engagement in CDR and FIMR activities, the National Center is creating an Education in QI for Pediatric Practice module that will help to leverage the unique strengths of CDR in understanding the youth mental health crisis. Pediatricians will be able to conduct continuous QI for youth suicide and suicide risk in their local communities. Data collected by CDR teams will be available to pediatricians to inform this activity. Successful completion of this activity can result in MOC4 credits.
These CDR-based QI projects can have substantial and widespread impact. In Maryland, pediatrician Scott Krugman, chair of the Baltimore County CDR team, was alarmed at the high rates of sudden unexpected infant death (SUID) in his community. He hypothesized that providing feedback to birth hospitals when an infant discharged from that hospital subsequently died suddenly and unexpectedly would prompt hospital staff to improve their educational processes. He worked with the local CDR team and the hospitals, such that any SUID becomes a “sentinel event” for the birth hospital, which receives a letter from the CDR team notifying them that an infant (deidentified) who had been born in their hospital had subsequently died, along with information about any unsafe sleep factors present. The hospital then must review their current procedures and what education is being delivered. Dr Krugman’s work has resulted in new hospital policies, improved educational efforts, and a decrease in local SUID rates.5
We hope that the articles in this supplement and the upcoming Education in QI for Pediatric Practice module will encourage more pediatricians to take advantage of the prevention opportunities provided through the CDR and FIMR teams. The more we learn from the tragedies that take the lives of the children in our communities, the better we all can be in our work to protect our young patients from preventable deaths.
Dr Moon made substantial contributions to the conceptualization and design of the manuscript, drafted the initial manuscript, and critically reviewed and revised the manuscript; Drs Quinlan and Collier made substantial contributions to the conceptualization and design of the manuscript, and critically reviewed and revised the manuscript for important intellectual content; and all authors approved the final version as submitted and agree to be accountable for all aspects of the work.
References
Competing Interests
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose.
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