The team should review as broad a category of deaths as possible to improve their ability to identify trends leading to enhanced prevention and policy development. There are three major criteria for selecting cases for review by a team:
Teams may also wish to maintain a list of and rationale for cases not selected. It is recommended that at least the medical examiner and one other team member make the case selections. These individuals determine cases to review using criteria established by the team.
It is recommended that all deaths to children age 18 and under be considered for review. However, teams can focus reviews on specific age groups or on other criteria based on interest and resources. Several counties now review deaths to persons age 21 and under. The decision may depend upon the expected workload and specific interests of a review team.
A review team can choose to review deaths in all categories. At a minimum, it is suggested that deaths in the following categories be reviewed:
- All medical examiner cases
- Undetermined causes
- Sudden or unexpected deaths
- All cases with previous DHS involvement, and all cases under investigation by law enforcement.
It is important not to focus only on cases involving child abuse, neglect or homicide. Deaths that are clearly caused by diseases such as cancer or congenital malformations are often not individually reviewed. However, it is important to inform teams of all natural deaths and to understand the cause and manner of these deaths to determine if patterns exist, e.g. clusters of deaths due to cancer.
Of special significance and difficulty for review teams are natural deaths to infants due to conditions originating in the perinatal period. These deaths represent a large percentage of all child deaths. Although classified as natural deaths, there are issues of preventability involved in many such deaths. Infants who die due to conditions occurring in the perinatal period are often low birth weight or preterm babies. Socioeconomic and environmental risk factors may be involved in these deaths. A review of all such local deaths by the Kent County Review Team found that approximately 50 percent could have been prevented. Teams are encouraged to review these types of deaths.
Because of the medical complexity involved in natural deaths to infants due to conditions originating in the perinatal period, the involvement of neonatologists, OB/GYN nurse specialists and other clinical specialists is encouraged. Review teams should also ascertain whether local or regional hospitals or health departments conduct fetal infant mortality reviews. If so, efforts should be made to share findings to develop comprehensive community recommendations.
Child death review teams should review all preventable deaths that occur in their counties and attempt to review deaths to children who are residents of their counties but die elsewhere.
In Michigan, death certificates are filed in the county where a death occurs. That county’s medical examiner has jurisdiction over these deaths. When a child dies in a county other than that of residence, the death is known as a non-resident occurrence.
If a team reviews a non-resident occurrence, the coordinator should notify the resident county review coordinator of the death in the event that the resident county will want to review the death as well. This is particularly important in rural counties whose children are often transported to tertiary care centers where they are pronounced dead.