Death-Scene Investigation in Sudden Infant Death

• Published in: The New England journal of medicine Vol. 315; no. 2; pp. 100 - 105
• Main Authors: Bass, Millard, Kravath, Richard E, Glass, Leonard
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 10.07.1986
• Subjects: Accidents, Home; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Asphyxia - diagnosis; Autopsy; Babies; Biological and medical sciences; Bronchopneumonia - diagnosis; Child abuse & neglect; Clinical death. Palliative care. Organ gift and preservation; Coroners and Medical Examiners; Diagnosis, Differential; Emergency medical care; Epidemiology; Female; Fever - diagnosis; Forensic pathology; Health risk assessment; Heat; Humans; Hyperthermia; Infant; Infant, Newborn; Infants; Injuries; Investigations; Male; Medical sciences; New York City; Paint removers; Pediatrics; SIDS; Socioeconomic Factors; Sudden Infant Death - epidemiology; Sudden infant death syndrome; Traumatic brain injury; New York City; Human; Infant; Sudden death
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198607103150206

We conducted death-scene investigations in 26 consecutive cases in which a presumptive diagnosis of sudden infant death syndrome (SIDS) was made and the infants were brought to the emergency room of the Kings County Hospital Center between October 1983 and January 1985. In six cases, we observed strong circumstantial evidence of accidental death. In 18 other cases, we discovered various possible causes of death other than SIDS, including accidental asphyxiation by an object in the crib or bassinet, smothering by overlying while sharing a bed, hyperthermia, and shaken baby syndrome. This study suggests that many sudden deaths of infants have a definable cause that can be revealed by careful investigation of the death scene and that the extremely high rate of SIDS (4.2 per 1000 live births) reported in the population of low socioeconomic status served by Kings County Hospital Center should be questioned. (N Engl J Med 1986; 315:100–5.) The diagnosis of sudden infant death syndrome (SIDS) is made by excluding known causes of death. However, the assessment of circumstances surrounding the sudden death of an infant is often minimal. After a brief interview with the family, the emergency room physician may provide a short note to the medical examiner, who usually performs the autopsy. When no underlying cause of death is detected, a diagnosis of SIDS is listed on the death certificate. Autopsies of infants who die of suffocation, carbon monoxide poisoning, occult trauma, or hyperthermia may also fail to reveal the cause of death, particularly if inadequate . . .