BEST PRACTICES
IN PREVENTION-ORIENTED
CHILD DEATH REVIEW


Our Process

The Best Practices in Prevention-Oriented Child Death Review site is tailored for child death review teams. These local- or state-level multidisciplinary teams regularly review unexpected child deaths to better understand how and why children die, and use the findings to take action to prevent other deaths and improve the health and safety of children.

Because injury remains the most prevalent cause of child death after the first year of life, this Best Practices site has been developed specifically for CDR teams as a flexible, searchable database of interventions that aim to prevent child injury death. Our site takes a critical look at the evidence behind each intervention, rating the intervention and providing additional resources for those that are promising or recommended.

Our first step in building the site was to develop mechanism-specific logic models for each mechanism. These logic models were based on a broad review of literature, along with input from experts in the field. Each logic model was tailored to reflect the types of intervention most useful and relevant to CDR teams operating in a public health system. Interventions that fall outside of the scope of CDR work are not included.

Using our logic models as guides, we then completed a careful review of the literature, summarizing interventions based on the strength of evidence available in published studies. We preferentially weighted studies that were methodologically rigorous (e.g. randomized trials), carefully conducted, or used serious injury and mortality as outcome measures. Other studies of lesser methodological rigor or those that tracked intermediate outcomes (such as behavior change) were included in our reviews but — in most cases — were not as influential in determining our ratings. In all cases, we required included studies to measure effectiveness with, at least, a comparison group of some type. Uncontrolled case series were not considered.

Our study group incorporated the results of this literature review and the input from content experts to rate each intervention in terms of the strength and quality of evidence supporting the injury prevention approach. Our goal was to highlight as "recommended" those interventions that should be the first consideration for CDR teams wanting to take action to address a local child injury concern. In some cases, with newer approaches have not been fully evaluated, we use the rating of "promising."

We recognize that this process of literature review and intervention rating is inherently subjective. Editorial decisions were made with respect to the breadth of study quality that we would include in our considerations¹ as well as the depth to which our librarian would go to uncover descriptions or studies of interventions in lesser known, poorly indexed or less recent media². Our decision-making was always driven by three considerations:

  1. Is the intervention or program in question likely to be relevant to the public-health oriented focus of most CDR team deliberations?


  2. Is the intervention widely practiced or promoted, to the degree that a clear understanding of the relevant evidence base is needed to guide resource allocation?


  3. Would additional data from these sources substantively change our overall assessment of the evidence base supporting the intervention in question?


References

  1. Ogilvie D, Egan M, Hamilton V, Petticrew M., Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? J Epidemiol Community Health. 2005 Oct;59(10):886-92.


  2. Ogilvie D, Hamilton V, Egan M, Petticrew M., Systematic reviews of health effects of social interventions: 1. Finding the evidence: how far should you go? J Epidemiol Community Health. 2005 Sep;59(9):804-8.