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Mortality in Cerebral Palsy (CP): The Importance of the Cause of CP on the Manner of Death

NCJ Number
Journal of Forensic Sciences Volume: 48 Issue: 5 Dated: September 2003 Pages: 1144-1147
Rachel S. Rosen; Vernon Armbrustmacher M.D.; Barbara A. Sampson M.D.
Date Published
September 2003
4 pages
This paper reports on the investigations and autopsies of 26 persons who had cerebral palsy (CP), so as to illustrate the importance of thorough investigations into the deaths of persons with CP.
The study reviewed the files of the Office of Chief Medical Examiner of the City of New York for the period of 1997-2001, with attention to any mention of CP. During those years, approximately 25,000 medical-examiner autopsies were performed, with 26 involving persons with CP. The majority of the deaths of those with cerebral palsy were natural (18 of 26); however, there were 2 homicides, 3 accidents, and 2 with therapeutic complications; 1 death was classified as undetermined. The case studies presented in this paper pertain to the two homicides and the case that involved an undetermined cause of death. The authors advise that in the investigation of alleged CP fatalities, the key questions that must be asked are whether neurologic impairment was present since birth and whether the CP was progressive. If the answer is "no" to either question, then further investigation is warranted. The importance of determining the answers to these questions is illustrated in one case cited in this paper. If the investigation into the cause of a 14-year-old boy's CP had not been done, his death would have been misclassified as natural rather than a homicide. Evidence of old injuries, such as healing fractures or a subdural neomembrane, should also prompt further investigation. Investigators should be aware that the challenge of caring for children with CP places them at risk for abuse and neglect. This was the case with a 5-year-old girl with severe CP who was starved to death because of the difficulties involved in caring for her. Although the majority of true CP deaths are natural, investigators should consider other possibilities that may be related to the quality of their care. 1 figure and 11 references