Garstang, Joanna, Ellis, Catherine, Griffiths, Frances and Sidebotham, Peter (2016) Unintentional asphyxia, SIDS, and medically-explained deaths : a descriptive study of outcomes of Child Death Review (CDR) investigations following sudden unexpected death in infancy. Forensic Science, Medicine, and Pathology, 12 (4). pp. 407-415. doi:10.1007/s12024-016-9802-0 ISSN 1547-769X.

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Abstract

Background:
A 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.
Methods:
This 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.
Results:
Data 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.
Conclusions:
The 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.

Item Type:	Journal Article
Subjects:	R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Sudden infant death syndrome, Infants -- Mortality
Journal or Publication Title:	Forensic Science, Medicine, and Pathology
Publisher:	Humana Press Inc
ISSN:	1547-769X
Official Date:	December 2016
Dates:	Date Event December 2016 Published 9 August 2016 Available 20 July 2016 Accepted
Volume:	12
Number:	4
Page Range:	pp. 407-415
DOI:	10.1007/s12024-016-9802-0
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	19 August 2016
Date of first compliant Open Access:	1 September 2017
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	(DRF 2010 03045)

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