June 15, 2017
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Reporting SUIDs, sleep-related infant deaths varied among medical examiners, coroners

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When examining the same cases, coroners and medical examiners within the United States are inconsistent in their practices regarding the identification and classification of sudden unexpected infant deaths, according to a study published in Pediatrics.

“Lack of standardized practices for investigation and cause-of-death determination result in inconsistent mortality estimates, which hinder accurate evaluation of temporal trends in mortality or changes in potentially hazardous factors,” Carrie K. Shapiro-Mendoza, PhD, MPH, from the division of reproductive health at the CDC, and colleagues wrote. “Because death certificate data are used to track state and national sudden unexpected infant death (SUID) trends, it is critical that death certificates be filled out accurately.”

Carrie Shapiro-Mendoza, PhD, MPH
Carrie K. Shapiro-Mendoza

The researchers claim that the lack of standardization has the ability to affect surveillance and research efforts in this field.

To measure the differences in cause-of-death certification, as well as to define what these differences are, the researchers led a nationally representative survey in which U.S. medical examiners who specialize in infant deaths classified hypothetical SUID scenarios. They were to then describe the evidence and procedures they used during the investigation. The sample was selected using a two-stage unequal probability sampling with replacement. After the surveys were complete, the researchers calculated frequencies and weighted percentages.

The responses to 377 complete and eligible surveys (801 mailed, 60% returned) demonstrated varying responses to the scenarios. Medical examiners and coroners determined that the cause of death for three infants who died from airway obstruction and had a negative autopsy was suffocation/asphyxia (61-69%). One case in which an infant died despite healthy sleep environments and good health with negative autopsy findings prompted the participants to classify the death as sudden infant death syndrome (38%) or SUID (30%).

The use of procedures varied by case; however, evidence was used frequently, with 88% reporting use of a full autopsy, 85% reporting use of a toxicology analysis and 82% reviewed the infant’s medical history.

“It is important to note that the four scenarios did not have correct answers,” Shapiro-Mendoza and colleagues wrote. “The survey was designed to elicit and represent the full range of responses death certifiers typically use for SUID. The variability in our results helps to demonstrate the importance of having a standardized process for certifying these deaths and the importance of getting certifiers to agree on a minimal set of criteria to define suffocation/asphyxia among infants.” — by Katherine Bortz

Disclosure: Please see the full study for a list of all relevant financial disclosures.