Assessment of caregiver responsibility in unintentional child injury deaths: Challenges for injury prevention

Background: Determining whether child abuse or neglect contributed to a death is a component of Child Death Review (CDR) in most states. Determining if a death is neglect-related, can be particularly challenging as differing definitions, lack of standards and changing norms may lead to lack of consensus. The purpose of this study was to assess CDR Team members' categorization of the extent to which unintentional injury deaths were neglect-related. Methods: CDR Team members were surveyed and asked to classify 20 vignettes, presented in 10 pairs that described the circumstances of unintentional injury deaths among children. Vignette pairs differed by an attribute that might affect classification, such as child age. Categories for classifying vignettes were: 1) caregiver not responsible / not neglect-related, 2) some caregiver responsibility / somewhat neglect-related, 3) caregiver responsible / definitely neglect-related. Results: CDR Team members from 5 states (n=287) completed surveys. Respondents assigned the child's caregiver at least some responsibility for the death in 18 vignettes (90%); exceptions were vignettes that described the death of a 15 year old in an all-terrain vehicle crash, and the death of 2 children in a fire caused by faulty wiring. A majority of respondents classified the caregiver as definitely responsible for the child's death in eight vignettes (40%). Conclusions: This study documents attributes that influence CDR Team members' decisions when assessing caregiver responsibility in unintentional injury deaths, including child age, supervision, intent, and a pattern of neglectful behavior. The findings offer insight for incorporating injury prevention into CDR more effectively.