Detecting Hidden Mechanisms of Abuse-Related Injury in Children: Structured Topic Modeling of Clinical Death Reviews and Legal Opinions

Mon, 24 Aug 2026 00:00:00 +0000

Presented at the ISPCAN World Congress on Child Abuse and Neglect, Melbourne, Australia, August 2426, 2026.

Full title: Detecting Hidden Mechanisms of Abuse-Related Injury in Children: Structured Topic Modeling of Clinical Death Reviews and Legal Opinions Triangulating Multidisciplinary Child Fatality Reviews with Factual and Procedural Narratives from Case Law

Abstract

Existing child maltreatment surveillance systems miss or misclassify between 8090% of maltreatment deaths, and CPS records undercount fatalities by 5576%. Unstructured narrative text clinical death reviews, court opinions, and social work records accounts for 8090% of all organizational data produced, yet it is rarely leveraged for injury surveillance.

This presentation introduces a two-study AI + Structured Topic Modeling (STM) pipeline that integrates two distinct narrative corpora to recover latent, abuse-related injury mechanisms that structured administrative codes routinely obscure.

Study Design

	Study 1: CFRT Death Reviews	Study 2: CourtListener Case Law
Source	Colorado Child Fatality Review Team reports	Appellate opinions retrieved from CourtListener
Documents	223 child-level narrative records	751 opinions → 335 confirmed cases from Ohio
Text	Two free-text fields per report (clinical + administrative)	Facts + procedural history
LLM Extraction	GPT-4o-mini: caregiver behavior, injury mechanism, setting, diagnosis	GPT-4o-mini: 9 structured fields including perpetrator, victim type, legal outcome
STM Models	Risk & Contributing Factors; Circumstances	Injury Mechanism; Long-Term Consequences
Covariate	Incident year (temporal prevalence)	Judicial ruling (affirmed / reversed)

Research Questions

Can large language models transform unstructured child fatality narratives into standardized semantic features caregiver behavior, injury mechanism, setting, diagnosis?
What latent themes emerge, and what typology of risk and incident circumstances do they suggest?
Do the recovered themes reveal recurring patterns of head and neck trauma consistent with abuse-related injury?
How does the prevalence of these themes shift across incident years (20202025)?

Key Findings

Both corpora converge on craniofacial injury as the dominant mechanism routinely undercounted by ICD codes.
Strangulation emerged as a critical lethality predictor; soft-tissue damage can surface 23 days post-injury, requiring clinician and court training on delayed sequelae.
Records document long-term neurological harm (cerebral palsy, pituitary damage, blindness) in children often years before clinical follow-up.
Children represent a structurally distinct injury profile in both datasets, warranting specialized clinical and legal protocols.
“Accidental” injuries (falls, environmental contact) are frequently embedded in an abuse context screening for mechanism, not just diagnosis, is essential.
Appellate opinions and death reviews function as injury-surveillance sources beyond structured administrative fields.

Methodology

The pipeline applies:

PDF parsing (pdftools) and regex isolation of narrative fields
GPT-4o-mini for LLM-based structured field extraction
Structured Topic Modeling (STM) with incident year or judicial ruling as a prevalence covariate
BART zero-shot classification as an independent supervised-style validation check
FREX word scoring (frequency � exclusivity) for topic labeling

Lab Members

This presentation was developed by the ISSUES Lab team at The Ohio State University:

Dr. Gia E. Barboza-Salerno (Founding Director), Dr. Henriikka Weir, Malcolm McCarthy, Dr. Karla Shockley McCarthy, Dr. Amy Watson-Grace, Dr. Keith Warren, Esenia Cassidy, and Olivia McLucas with collaborators Scottye Cash and Suzanne Perkins.

📄 Presentation

Download the presentation slides here .

Structured Topic Modeling of Child Fatal Injury Narratives Using Machine Learning with County-Level Demographic Indicators to Strengthen Prevention Strategies

Wed, 01 Jan 2025 00:00:00 +0000

Plain-Language Summary

This study applies machine learning and natural language processing to analyze child fatality reports in Pennsylvania from 2016 to 2023. Unstructured text narratives from child death investigations were combined with census data to identify recurring themes and environmental factors surrounding child neglect and traumatic injuries.

Using structured topic modeling, the researchers identified 11 distinct circumstances of death, including substance misuse, sleep-related deaths, firearms, and supervisory neglect. The analysis showed that counties with higher poverty levels and larger non-White populations experienced a higher prevalence of firearm-related and severe traumatic injuries. The findings demonstrate how combining clinical narratives with machine learning can strengthen fatality surveillance and help construct more effective, targeted prevention programs.

Child Fatality | ISSUES | The Ohio State University