Accurate Ascertainment of Child-Abuse Mortality

To the Editor: The article by Dr Herman-Giddens and colleagues¹ contributes to the literature on the scope of the child abuse problem by providing an estimate of underreporting in vital statistics. Similar studies² provide estimates of reliability for other causes of death.

Two reasons account for differences in estimates of child abuse deaths between the vital statistics system and those of the authors' comprehensive case fatality review: (1) the availability of information on circumstances of the death and (2) definitional differences. Herman-Giddens et al reviewed a broad range of information from which child abuse could be inferred, including medical examiners' reports, autopsy reports, toxicology reports, and case notes. In contrast, ascertainment of child abuse in vital statistics depends entirely on the cause of death reported by the medical examiner, coroner, or attending physician. This is the only information available to the mortality medical coder to make judgments or …