Traumatic and other non-natural childhood deaths in Manitoba, Canada: A retrospective autopsy analysis (1989-2010)

OBJECTIVE: The goals of analyzing all non-natural childhood deaths in Manitoba for the 22-year period (1989-2010) are to highlight preventable causes of death and to document temporal trends that might be influenced by changes in society. METHODS: The 1989 to 2010 pediatric autopsy database at the Winnipeg Health Sciences Centre and records from the Office of the Chief Medical Examiner were searched for all non-natural deaths <= 18 years age. All files were reviewed in detail. Data collected included demographic characteristics, manner of death, details of cause and circumstances leading to death, and survival time after the event. RESULTS: For the 22-year period, the total number of non-natural childhood deaths after which autopsy was performed in Manitoba was 581 for males and 409 for females in a population of approximately 1.23 million (2010 estimate). This represents 22.1% of the total childhood deaths in Manitoba during the study period. A higher proportion of children living in rural and northern communities died from non-natural causes. Of all accidents, which peaked in 1999, road traffic incidents accounted for the majority. Of suicides, which peaked in 2005, hanging in the 15-18 year group accounted for almost all cases. Of homicides, child abuse deaths at <3 years age was the most frequent cause. For all causes, most individuals were dead at the scene or died shortly thereafter. CONCLUSIONS: Most non-natural childhood deaths in Manitoba might be avoidable through education about prevention strategies and by correction of social inequities. Improved transportation to hospital from remote locations would likely have little impact on survival.