Traumatic and other non-natural childhood deaths in Manitoba, Canada: A retrospective autopsy analysis (1989–2010)

Abstract

anner 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 (nonnatural 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 universityaffiliated 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.

Cases of asphyxia in children and adolescents: a retrospective analysis of fatal accidents, suicides, and homicides from 1998 to 2017 in Hamburg, Germany

“…The largest number of asphyxia cases involved adolescents and young adults aged 15-21 years, and most incidents occurred at home with the exception of drowning, which occurred predominantly in public bodies of water. This distribution is consistent with previous publications in studies of non-natural child deaths in Estonia, Canada, Sri Lanka, Turkey, and the USA [12][13][14][15][16].…”