The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse

Abstract

In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence‐based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma‐related and nontrauma‐related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).

Introductory evidence on data management and practice systems of forensic autopsies in sudden and unnatural deaths: a scoping review

“…Eight of the 16 articles were published between 2017 and 2019 (Soto Martinez et al 2019 ; Dunstan 2019 ; Fowler et al 2018 ; Hargrove et al 2018 ; Dennis et al 2018 ; Saar et al 2017 ; Hofmeister et al 2017 ; Ottaviani et al 2017 ). Most of the studies were published in the USA (Soto Martinez et al 2019 ; Fowler et al 2018 ; Hargrove et al 2018 ; Levy 2015 ; Blair et al 2016 )and Australia/New Zealand (Willcox et al 2020 ; Dunstan 2019 ; Saar et al 2017 ; Lyndal et al 2016 ; Pearse 2012 ) and three from European countries. Two publications were from LMIC (Nigeria, Mexico), and the remaining were from high-income countries (Italy, Denmark, USA, Australia, and New Zealand, Japan, Switzerland, Canada (Fig.…”

“…1 ). The article types included brief communication (Ottaviani et al 2017 ; Kiuchi et al 2013 ), original studies (Dunstan 2019 ; Saar et al 2017 ; Hofmeister et al 2017 ; Levy 2015 ; Aghayev et al 2008 ), author manuscript (preprint) (Blair et al 2016 ), retrospective descriptive studies (Soto Martinez et al 2019 ; Fowler et al 2018 ; Hargrove et al 2018 ; Dennis et al 2018 ; Kipsaina et al 2015 ; Colville-Ebeling et al 2014 ), a single systematic review (Lyndal et al 2016 ), and an annual/government report (Canada 2012 ).…”

“…Data collected from individual information sources are entered into the NVDRS online data entry system with quality checks, training, and quality checks Used to define public health priorities, develop and evaluate programs and policies, conduct research. Online platform simplified system operations and management, improved timeliness of data entry and reporting, enhanced flexibility Not nationally representative, availability completeness and timeliness of data dependent on partnerships among state health departments, sharing and communication challenges, incomplete data, toxicology data not consistently collected, different classifications of deaths, different coding, protective factors not collected Dennis, 2018 Australia National Coronial Database funded by a governmental association Study showed an opportunity to institute preventative measures (CPR training and defibrillators), outcomes improved possibly due to an increase in witnessed events, looked at preparticipation screening Low number of cases, retrospective, not standardized data, missed cases Soto Martinez, 2019 USA A web-based platform, the Research Electronic Data Capture (REDCap) platform. Migration of the IID to a REDCap platform provided an opportunity to redesign the database to capture internal, external, and skeletal injuries with greater detail Used to develop statistically sound diagnostic models, reliable, autopsy gold standard Small number of cases, errors, complexity of observations, autopsy sample therefore not complete complement of injuries Dunstan, 2019 Australia and New Zealand National Coronial Information System Data sharing with statistical and research data, identify mortality trends, formulate effective recommendations in the prevention of death and injury, contribution to health policy and prevention, access levels, ethics application process to obtain data Reports only on closed cases, although nationally standardized information availability may vary, not all fatalities reported, no transcripts, photographic evidence or witness statements, non-fatal injury data, or information on the perpetrator Blair, 2016 USA NVDRS created in response to a 1999 Institute of Medicine report outlining the need for a national fatal intentional injury system, the first multistate system to provide detailed information on circumstances precipitating violent deaths, the first to link multiple source documents on violence-related deaths to enable researchers to understand each death more completely, and the first to link multiple deaths that are related to one another (e.g., multiple homicides, multiple suicides, and cases of homicide followed by the suicide of the suspected perpetrator) ...…”

“…Forensic Medicine and Forensic Pathology apply scientific and medical knowledge to inquests, and the autopsy is frequently regarded as the focus of the death investigation. The investigation into sudden unexpected and unnatural deaths supports criminal justice, aids in litigation, and provides important information for public health including surveillance, epidemiology, and prevention programs (Bagher et al 2015 ; Tseng et al 2018 ; Barbería et al 2018 ; Pan et al 2019 ; Soto Martinez et al 2019 ). The evidence serves to inform policy not only for injury prevention and control but also to prevent suicide, violence, or substance abuse (Barbería et al 2018 ; Pan et al 2019 ; Rao et al 2005 ; Grills et al 2011 ; Prinsloo 2019 ; Willcox et al 2020 ).…”

The first step in an investigation of quantitative ultrasound as a technique for evaluating infant bone strength

“…The study sample consists of infants between the ages of 30 weeks gestation (actual or corrected) at birth to 1 year postnatal at the time of death who received autopsies at the HCIFS or Texas Children's Hospital (TCH) in Houston, Texas between November of 2013 and February of 2018. This study sample consists of infants included in the Infant Injury Database, which has previously been described by Soto Martinez et al [42]. SOS data was prospectively collected from autopsied infants regardless of medical history or the circumstances surrounding death.…”