Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA.
Inj Prev. 2011 Feb;17 Suppl 1:i45-54. doi: 10.1136/ip.2010.027094.
Most unintentional injury deaths among young children result from inadequate supervision or failure by caregivers to protect the child from potential hazards. Determining whether inadequate supervision or failure to protect could be classified as child neglect is a component of child death review (CDR) in most states. However, establishing that an unintentional injury death was neglect related can be challenging as differing definitions, lack of standards regarding supervision, and changing norms make consensus difficult. The purpose of this study was to assess CDR team members' categorisation of the extent to which unintentional injury deaths were neglect related. 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 poverty or intent. 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. CDR team members from five states (287) completed surveys. Respondents assigned the child's caregiver at least some responsibility for the death in 18 vignettes (90%). A majority of respondents classified the caregiver as definitely responsible for the child's death in eight vignettes (40%). This study documents attributes that influence CDR team members' decisions when assessing caregiver responsibility in unintentional injury deaths, including supervision, intent, failure to use safety devices, and a pattern of previous neglectful behaviour. The findings offer insight for incorporating injury prevention into CDR more effectively.
大多数幼儿意外伤害死亡是由于照顾者监督不力或未能保护儿童免受潜在危险造成的。确定监督不足或未能保护是否可以归类为儿童忽视是大多数州儿童死亡审查 (CDR) 的一个组成部分。然而，确定意外伤害死亡是否与忽视有关可能具有挑战性，因为不同的定义、缺乏监督标准以及不断变化的规范使得达成共识变得困难。本研究旨在评估 CDR 小组成员对意外伤害死亡与忽视相关程度的分类。对 CDR 小组成员进行了调查，并要求他们对 20 个描述儿童意外伤害死亡情况的情景进行分类，这些情景以 10 对的形式呈现。情景对通过可能影响分类的属性（如贫困或意图）而有所不同。用于分类情景的类别包括：(1) 照顾者无责任/与忽视无关；(2) 照顾者有部分责任/有些忽视相关；(3) 照顾者有责任/肯定与忽视有关。来自五个州的 CDR 小组成员（287 人）完成了调查。在 18 个情景中，有 18 个（90%）受访者认为孩子的照顾者对死亡负有至少部分责任。大多数受访者将照顾者归类为对孩子的死亡负有绝对责任的有八个情景（40%）。本研究记录了影响 CDR 小组成员在评估意外伤害死亡中照顾者责任时做出决策的属性，包括监督、意图、未能使用安全装置以及先前忽视行为的模式。这些发现为更有效地将伤害预防纳入 CDR 提供了深入了解。
