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January 19, 2000

Accurate Ascertainment of Child-Abuse Mortality—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(3):337-338. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-3-jac90010

In Reply: Dr Rosenberg and Ms Freedman stress 2 of the causes we cited for differences in the number of child abuse deaths recorded by the vital statistics system and the number obtained in our study. We appreciate their further elaboration on the limitations under which nosologists function and their recognition of the need to improve documentation of child abuse homicides. Our intent was to demonstrate that death certificate data, as currently collected, yield a significant underascertainment of child abuse fatality incidence and rates. We did not mean to impugn the vital statistics system, which we found to provide timely and accurate data under the limitations in which it must operate.