Each year, approximately 600 children under age 18 die in Colorado. The Colorado Department of Public Health and Environment (CDPHE) has conducted multidisciplinary reviews of child deaths since 1989. In 2005, these efforts were codified into the Colorado Revised Statutes (C.R.S.) with the enactment of the Child Fatality Prevention Act, establishing the Colorado Child Fatality Prevention System (CFPS). The CFPS conducts reviews of all deaths of children ages 0-17 years that occur in Colorado. Using a public health approach, the CFPS aggregates data from individual deaths, describes trends and patterns of preventable child deaths, and identifies prevention strategies. These strategies are implemented and evaluated at the state and local levels with the goal of preventing similar deaths from occurring in the future.
The comprehensive review of Sudden Unexpected Infant Death (SUID) cases is particularly important because the cause of death in these cases is often not immediately obvious. Causes of SUID are most often reported as: Sudden Infant Death Syndrome (SIDS), accidental sleep-related suffocation, asphyxia, or undetermined causes. However, SUID cases are frequently subject to misclassification when the infant death is not thoroughly investigated and information necessary for determining the cause of death is not collected or is inconsistently reported. Accurate diagnosis and classification of SUID is essential to accurate monitoring of trends and the identification of common risk factors as well as to the subsequent development of risk-reduction or prevention strategies.
In Colorado, SUID is a leading cause of death in the CFPS with an average of 45 SUID cases a year. Between 2011 and 2015, 224 SUID cases occurred in Colorado, accounting for 12.6 percent of all infant deaths (under 1 year of age). Although the rate of SUID among Colorado residents per 100,000 live births trended downward between 2011 and 2015, this decrease did not achieve statistical significance. Out of the 216 identified SUID occurring among Colorado residents, 185 (85.7 percent) occurred in urban counties and 31 (14.3 percent) occurred in rural or frontier counties. Consistent with national trends, the majority of SUID occurred among those under 5 months (70.5 percent, n=158). In addition, Colorado observed a significant disparity in the rate of SUID by race and ethnicity where the rate among non-Hispanic Black or African American decedents was 2.8 times higher (167.3 per 100,000 live births) than for non-Hispanic White decedents (59.7 per 100,000 live births).
The purpose of the Colorado SUID Case Registry is to improve the quality, utility and impact of SUID data. The proposed project will ensure Colorado’s ability to maintain the Colorado SUID Case Registry and to achieve the overarching goal to reduce the incidence of SUID in Colorado by 15 percent from 49 in 2016 to 39 in 2023. To reach this goal, Colorado will implement the following strategies: 1) identify all SUID within 30 days of death; 2) conduct multidisciplinary reviews of all SUID within 90 days of identification; 3) categorize each SUID using the SUID Categorization Algorithm; 4) enter all case information within 30 days of review; 5) perform quality assurance checks/protocols on all cases within 90 days of entering case information; 6) analyze and disseminate data to internal and external audiences to inform practice and policy changes; and 7) participate in evaluation and performance measurement activities to monitor outputs and outcomes and track results of the cooperative agreement.