Comparative evaluation of diagnostic guidelines for sudden infant death syndrome (SIDS) in Japan

It is a well-recognized fact among professionals that the diagnosis of sudden infant death syndrome (SIDS) involves difficult elements; a SIDS diagnosis is not uniform throughout Japan; and such a diagnosis is not made based on any internationally recognized definition. Faced with this situation, guidelines have been prepared and proposals have been made to standardize and improve the accuracy of SIDS diagnoses, viz. the following three can be cited: "guideline for diagnosis of SIDS" prepared by a Study Group of the Ministry of Health and Welfare; "case studies of SIDS" and a "guideline for its diagnosis" prepared by the Case Study Committee of Japan SIDS Research Society; and a "proposal on the principles of medico-legal pathology concerning SIDS", included in the research report supported by a Grant-in-Aid for Scientific Research from the Ministry of Education. In the current study, a comparison was made focusing on the discrepancies among these three documents. The major discrepancies among these three are: (1) handling of the patient's age (by months or years) in the diagnosis of SIDS; (2) dealing with those cases for which no autopsy has been conducted; (3) attitudes concerning whether sleeping in a prone posture is a cause for asphyxia and (4) opinions concerning the aspiration of vomited milk. It is anticipated that these discrepancies will invite confusion and affect judgments and recognition of SIDS-related cases that will be brought to court. It is essential that those involved with these three documents have an opportunity at the earliest time to discuss the matter and come to a uniform understanding.