Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting

Brixey, Suzanne N.; Kopp, Brianna; Schlotthauer, Amy E.; Collier, Abigael; Corden, Timothy E.

doi:10.1136/ip.2010.027037

Cited by 20 publications

(19 citation statements)

References 17 publications

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“…Risk factors for SIDS are well known including parental smoking [4], hazardous sleeping environments [5] and prone sleep position [6]. Some SUDI are caused by unintentional asphyxia such as overlaying by a parent; these deaths are difficult to determine as SIDS deaths and those from unintentional asphyxia have many features in common [7]. Differentiation between SIDS and unintentional asphyxia relies on parental accounts and scene examinations because post-mortem examination findings are often insignificant [8] and not diagnostic [9].…”

Section: Introductionmentioning

confidence: 99%

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Garstang

Ellis

Griffiths

et al. 2016

Forensic Sci Med Pathol

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BackgroundA comprehensive Child Death Review (CDR) program was introduced in England and Wales in 2008 but as yet data have only been analysed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for Sudden Unexpected Death in Infancy (SUDI) as determined by the new CDR program. MethodsThis was a descriptive outcome study using data from Child Death Overview Panel (CDOP) Form C for SUDI cases dying during 2010-2 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia. ResultsData were obtained for 65/70 (93%) SUDI cases. 20/65 (31%) deaths were initially categorised as due to medical causes; 21/65 (32%) as SIDS, and 24/65 (37%) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as 'undetermined' had significantly higher total family and environmental risk factor scores (mean 2.6, 95% CI 2.0-3.3) compared to those classified as SIDS (mean 1.6, 95% CI 1.2-1.9), or medical causes for death (mean 1.1, 95% CI 0.8-1.3). 9/20 (47%) of medical deaths, 19/21 (90%) SIDS and 23/24 (96%) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25%) of medically explained deaths. ConclusionsThe CDR program results in detailed information about risk factors for SUDI cases but failed to recognise deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as 'undetermined deaths' is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep-environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future. Key Words Key pointsThe CDR program provides valuable information on the profile of causes and risk factors for SUDI but is currently not recognising deaths from unintentional asphyxia and often not classifying unexplained infant deaths as SIDS.Most SUDI still occur in hazardous sleep environments despite public health campaigns.Poor parenting, particularly the combination of excess parental alcohol consumption and cosleeping, was a factor in many unexplained SUDI deaths.Research is needed to help target safe-sleep information better at high risk families.Difficulties with health care service provision may have contributed to some medically explained deaths.

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Section: Introductionmentioning

confidence: 99%

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Garstang

Ellis

Griffiths

et al. 2016

Forensic Sci Med Pathol

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“…40 It should be noted that this analysis was unable to account for injury fatalities that may have been misclassified as deaths due to natural causes, which is a limitation, given difficulties in distinguishing sudden infant death syndrome from injury suffocation deaths. [47][48][49] Finally, while research suggests that the physical wellbeing of nonambulatory infants and young children is largely defined by the adequacy of age-appropriate supervision and caregiving, 25,50-52 variability in children's exposure to neighborhood or environmental hazards cannot be ignored. Among children residing in impoverished and dangerous neighborhoods, it may be that a smaller fraction of injury fatalities can be attributed to parental factors associated with the risk of maltreatment.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Preventable Injury Deaths: A Population-Based Proxy of Child Maltreatment Risk in California

Putnam‐Hornstein

2012

Public Health Rep

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Objective. This study used group variations in child injury fatality rates to assess racial bias in the population of children identified as victims of maltreatment.Methods. Injury fatality and maltreatment data from California were compiled for the years 1998-2007. Death and maltreatment risk ratios (RRs) and 95% confidence intervals (CIs) were computed by race and age. Rates of excess child injury mortality by race were derived from three different baseline rates of death. Substantiations per excess injury death were calculated.Results. Compared with white children, black children faced a risk of substantiated maltreatment that was more than twice as great (black RR: 2.39, 95% CI 2.37, 2.42) and were fatally injured at nearly twice the rate (black RR: 1.89, 95% CI 1.68, 2.12). Per excess death, however, black children had rates of substantiated maltreatment allegations that were equivalent to or lower than the rates for white children.Conclusions. These data support claims that, at least in California, black-white racial disparities observed in maltreatment rates reflect real group differences in risk. These data provide no evidence of systematic racial bias in the child protective services' substantiation process.

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“…The most effective death scene investigations were reported where one public health nurse conducted all SUDI death scene investigations for the region [10]; this resulted in considerably more complete information than the use of the US national templates by multiple death scene examiners [11,12] or when there was no information concerning or variable use of templates [13][14][15]. Trained death scene examiners did obtain detailed information concerning the scene but frequently missed relevant information on other risk factors such as parental smoking [16].…”

Section: Coroner or Medical Examiner-led Models Of Sudi Investigationmentioning

confidence: 99%

“…SUDI models that have strong leadership have higher rates of completed investigation. Based on strong evidence - [12,11,10,25] …”

Section: Strong Leadership By a Sudi Policy Championmentioning

confidence: 99%

See 1 more Smart Citation

An evidence-based guide to the investigation of sudden unexpected death in infancy

Garstang

Ellis

Sidebotham

2015

Forensic Sci Med Pathol

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MethodsThis was a systematic review of papers from Europe, North America and Australasia, detailing models of SUDI investigation or the outcomes of SUDI investigations. ResultsThe review includes data detailing four different models of investigation: police-led, coroner or medical examiner-led, healthcare-led or joint agency approach models.There were 18 different publications providing evidence of effectiveness of these models. All models, with the exception of police-led models have the potential to reach best practice standards for SUDI investigation. Key factors identified for effective SUDI investigation include the need for mandatory investigation, strong leadership, integration with coronial services and for investigations to be provided by specialist professionals.3 ConclusionDetailed SUDI investigation should lead to greater understanding of why infants die and should help prevent future deaths. The challenge is now to ensure that local SUDI investigative practices are as effective as possible. (208 words

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Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting

Abstract: The study demonstrates how CDR provides enhanced documentation of risk factors to help steer prevention efforts regarding SUID deaths in a community and reaffirms infants in an unsafe sleep environment have an increased risk of death.

Cited by 20 publications

References 17 publications

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Preventable Injury Deaths: A Population-Based Proxy of Child Maltreatment Risk in California

An evidence-based guide to the investigation of sudden unexpected death in infancy

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