A new study revealed that coroners and medical examiners in the United States might not precisely classify some sudden unexpected infant deaths or SUIDs, because some of them follow different procedures when classifying and investigating such deaths.
The research team surveyed approximately 400 coroners and medical examiners in 2014. The findings raises doubts about the dependability of the current SUID reporting procedures, given the probability that a notable number of SUID cases are being incorrectly attributed to other causes of infant death.
“Death investigation guidelines exist,” said lead author Carrie Shapiro-Mendoza, a researcher in the maternal and infant health branch of the U.S. Centers for Disease Control and Prevention.
The CDC has its own classification system, which includes standards for how cause-of-death should be determined during an infant death investigation.
“[But] U.S. medical examiners and coroners do not uniformly investigate and classify SUID,” Shapiro-Mendoza said.
“Because of that, they certify the same death differently. This variability influences surveillance and research impacts true understanding of infant mortality causes and inhibits our ability to accurately monitor and ultimately prevent future deaths,” she said.
According to the U.S. Institute of Child Health and Human Development, when a baby less then 1-year-old dies unexpectedly and suddenly dies as a result of entrapment between two objects, suffocation, choking, an infection, injury, heartbeat irregularity or breathing problems, the death is classified as SUID.
Sudden Infant Death Syndrome or SIDS is a type of SUID. When a medical examiner cannot determine the true cause of the infant’s death, despite a clinical review, death scene examination and full autopsy, the death will be classified as SIDS.
The coroners and medical examiners were given four hypothetical infant death scenarios and asked how they would handle the examination, before giving a final classification for each of the scenarios. The participants were mostly male and over the age of 50.
Of those surveyed 64 to 77 percent determined that the cause of death for the first three scenarios was asphyxia and suffocation, while another 15 percent determined the cause to be something entirely different.
Nearly 40 percent of the participants determined the cause of death was SIDS, while another 30 percent said it was SUID. Less than 1 percent determined the cause of death was asphyxia or suffocation.
Half of the participants said throughout the course of their work they utilized SIDS as the determination of death, while the other half said they had not.
When SUIDs and SIDS was considered, the definitions utilized to find a determination differed greatly. The diagnostic screening tools utilized to determine the cause of death also varied significantly.
For example, the participants utilized metabolic screenings routinely about 80 percent of the time, while radiology screenings were only routinely utilized about 60 percent of the time and genetic testing only 7 percent of the time.
The findings reveal that 94 percent of the participants admitted to relying on death scene investigation reports to determine the cause of infant death, while fewer (88 percent) of the participants said they performed a full autopsy. Only 85 percent of the participants performed a toxicology analysis and 82 percent conducted a review of a baby’s medical history.
The study was published in the journal Pediatrics on June 5, 2017.