Academic journal article Canadian Journal of Public Health

Traumatic and Other Non-Natural Childhood Deaths in Manitoba, Canada: A Retrospective Autopsy Analysis (1989-2010)

Academic journal article Canadian Journal of Public Health

Traumatic and Other Non-Natural Childhood Deaths in Manitoba, Canada: A Retrospective Autopsy Analysis (1989-2010)

Article excerpt

Manner of death is categorized as natural, accident, suicide, homicide and undetermined. Death may be due to disease (i.e., natural) or external factors. Statistics Canada reported that during the period 2004-08, the leading causes of death in children were accidental injuries (~30%), malignant neoplasms (~16%), congenital anomalies (~8%), suicide (~4%), heart disease (~4%) and assault (~3%).1 Injuries are the leading cause of childhood death in developed nations, accounting for almost 40% of deaths between 1 and 14 years.2 In Canada in 2004, there were >13,000 deaths and 211,000 hospitalizations due to injury with a total cost of CAD $19.8 billion; children aged 15-19 years accounted for a substantial proportion of these.3,4 In Manitoba, 1994-97 administrative data indicate that injuries accounted for >50% of all deaths at 1-9 years of age and 70% of deaths at 10-19 years of age.5

Most mortality statistics are derived from administrative databases, which are subject to coding errors. Retrospective autopsy review potentially offers more detailed and accurate information. Statistics Canada data indicate that the percentage of deaths subjected to autopsy in 1991 was 16.9% and had declined to a national average of 5.7% in 2007. In Manitoba, the autopsy rate was considerably higher, at 10.5%, although comparisons for the pediatric population are not available.6 Manitoba has highly centralized health care. The death investigation system is coordinated by the Office of the Chief Medical Examiner (OCME). In Manitoba, all child deaths (non- natural and natural deaths of individuals <19 years of age) are reportable to the OCME. Manitoba has Canada's oldest multidisciplinary child death review committee, formed in 1992 through the Provincial Advisory Committee on Child Abuse.

Because of the centralized death investigation system, it is possible to analyze all childhood deaths retrospectively. During the study period, almost all autopsies were performed in two university- affiliated hospitals in Winnipeg and a small proportion in a third hospital in Brandon. More than 95% of the pediatric autopsies were done at a single centre in Winnipeg. Most were performed by pathologists with broad forensic experience, often in consultation with a neuropathologist. The goals of analyzing all non-natural childhood deaths in Manitoba for the 22-year period are to document temporal trends that might be influenced by changes in society and to highlight preventable causes of death.

METHODS

This is a retrospective study of deaths among children aged 0-18 years inclusive residing in the Province of Manitoba from 1989 to 2010. The study was approved by the Research Ethics Board of the University of Manitoba (protocol H2009:338). Databases used included the pediatric autopsy records and files of the OCME. Most autopsy records were located at the Health Sciences Centre, where >95% of child medicolegal autopsies have been conducted.

The OCME records were used to enumerate the manner of childhood death, which is a legal designation of natural, accident, suicide, homicide and undetermined. The cause of death is a biological consideration that comprises a multitude of diseases as well as external causes (including accidental trauma, poisoning, intentional self-harm and assaults). Information included year of death, age at time of injury/death, sex, manner of death (homicide, suicide, accidental, undetermined), cause of death, body regions affected by trauma (head, neck, chest, abdomen, pelvis, upper limbs, lower limbs) and survival time between the event and death. The age grouping was 0-1 years, 2-4 years, 5-9 years, 10-14 years and 15-?18 years (rounded to the nearest integer). Causes were categorized as trauma due to motor vehicle/traffic/pedestrian accidents, blunt or sharp force assault or falling; and poisoning, choking, hanging, drowning, environmental exposure, burns or smoke inhalation sustained in (mainly house) fires, animal attack, gunshot and electrocution. …

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