Children's Deaths at Day-Care Facilities

In the US, there is no mechanism readily available to identify children who die while attending day care. The National Center for Health Statistics (NCHS) uses the International Classification of Diseases 9th Edition (ICD-9) to categorize US mortality data; however, the International Classification of Diseases does not contain a category for "day care" as the place of death. Thus, researchers using NCHS mortality data are unable to count day-care deaths on a national basis. To identify children who died while in day care, it is necessary to review the records of those who investigated the deaths. In most counties and states, medical examiners or coroners (ME/C) are responsible for investigating unusual and sudden deaths. Their records often contain detailed information on the place and circumstances of death. The Medical Examiners and Coroners Information Sharing Programs (MECISP) at the Centers for Disease Control and Prevention (CDC) works with state and local medical examiners and coroners to improve the availability of data on deaths that they investigate. Computerized data are gathered on all deaths investigated by participating ME/C offices; data are obtained from six state and seven county jurisdictions. These jurisdictions have a combined population of 37 million people and record 56 000 deaths per year. Of these jurisdictions, one state and three county offices have text within their computerized data that describes the circumstances, place, and cause of each death. The objective of our study was to demonstrate the usefulness of ME/C death-investigation records as a means of identifying and characterizing the types of deaths that occur among children while attending day care facilities.