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Patricia G. Schnitzer, PhD, Theresa M. Covington, MPH, Stephen J. Wirtz, PhD, Wendy Verhoek-Oftedahl, PhD and Vincent J. Palusci, MD, MS

Patricia G. Schnitzer is with the Sinclair School of Nursing, University of Missouri, Columbia. Theresa M. Covington is with the National Center for Child Death Review Policy and Practice, Michigan Public Health Institute, Okemos. Stephen J. Wirtz is with Epidemiology and Prevention for Injury Control, California Department of Health Services, Sacramento. Wendy Verhoek-Oftedahl is with the Department of Community Health, Brown Medical School, Providence, RI. Vincent J. Palusci is with the Department of Pediatrics, Wayne State University School of Medicine, Detroit, Mich.

Correspondence: Requests for reprints should be sent to Patricia G. Schnitzer, PhD, Assistant Professor, S331, Sinclair School of Nursing, University of Missouri, Columbia, MO 65211 (e-mail: schnitzerp{at}health.missouri.edu).

Objectives. We sought to describe approaches to surveillance of fatal child maltreatment and to identify options for improving case ascertainment.

Methods. Three states—California, Michigan, and Rhode Island—used multiple data sources for surveillance. Potential cases were identified, operational definitions were applied, and the number of maltreatment deaths was determined.

Results. These programs identified 258 maltreatment deaths in California, 192 in Michigan, and 60 in Rhode Island. Corresponding maltreatment fatality rates ranged from 2.5 per 100000 population in Michigan to 8.8 in Rhode Island. Most deaths were identified by child death review teams in Rhode Island (98%), Uniform Crime Reports in California (56%), and child welfare agency data in Michigan (44%). Compared with the total number of cases identified, child welfare agency (the official source for maltreatment reports) and death certificate data underascertain child maltreatment deaths by 55% to 76% and 80% to 90%, respectively. In all 3 states, more than 90% of cases ascertained could be identified by combining 2 data sources.

Conclusions. No single data source was adequate for thorough surveillance of fatal child maltreatment, but combining just 2 sources substantially increased case ascertainment. The child death review team process may be the most promising surveillance approach.

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