Postmortem skeletal survey practice in pediatric forensic autopsies: a national survey
Related Experiment Video
Updated: Jun 27, 2026
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Antoinette L Laskey1, Kelly L Haberkorn, Kimberly E Applegate
1Department of Pediatrics, Riley Hospital for Children, Children's Health Services Research, Indiana University School of Medicine, 410 West 10th Street, Suite 1020, Indianapolis, IN 46202, USA. alaskey@iupui.edu
Insights
Forensic pathologists often omit postmortem skeletal surveys (PMSS) in infant deaths, despite recommendations. This practice gap, particularly in Sudden Infant Death Syndrome (SIDS) cases, highlights a need for improved adherence to guidelines for evaluating unexplained infant deaths.
Area of Science:
- Forensic Pathology
- Pediatric Autopsy
- Child Death Investigation
Background:
- Postmortem skeletal surveys (PMSS) are recommended for evaluating unexplained infant deaths to rule out skeletal trauma.
- Adherence to PMSS guidelines in pediatric forensic autopsies is crucial for accurate death investigation.
Purpose of the Study:
- To assess the adherence to postmortem skeletal survey (PMSS) recommendations in forensic autopsies of children up to 36 months.
- To identify factors influencing the use or nonuse of PMSS in pediatric forensic practice.
Main Methods:
- A survey was distributed to pathologists who are members of the American Academy of Forensic Sciences.
- The survey collected data on practice characteristics, including the performance and circumstances of PMSS.
Main Results:
- Nearly all respondents (99.6%) perform PMSS, but nearly a third do not use it for all suspected SIDS, abuse, unsafe sleep, or undetermined deaths.
- Despite recommendations, 30% of pathologists use inappropriate "babygrams" preferentially, and almost 10% do not order PMSS for SIDS cases.
- Significant variation exists in the application of PMSS across different suspected causes of infant death.
Conclusions:
- Adherence to postmortem skeletal survey (PMSS) recommendations in pediatric forensic autopsies is suboptimal.
- Barriers to the consistent use of PMSS in infant death evaluations need further research and intervention.
- Ensuring universal PMSS use is vital for accurate diagnosis in unexplained infant deaths, including SIDS.
Abstract:
Recommendations for the evaluation of an unexplained death in infancy include a postmortem skeletal survey (PMSS) to exclude skeletal trauma. Objectives of this study were to assess adherence to these recommendations in forensic autopsies in children equal to or less than 36 months of age, and what factors influence the use or nonuse of the PMSS. We surveyed pathologists who were members of the American Academy of Forensic Sciences. The survey included practice characteristics about where, when, and how PMSS were done. Nearly all respondents (99.6%) indicated they performed PMSS at least some of the time; however, almost a third did not use PMSS for all suspected Sudden Infant Death Syndrome (SIDS), abuse, unsafe sleep, or undetermined causes of death. Despite evidence that "babygrams" are inappropriate in a SIDS workup, 30% of pathologists use them preferentially. Despite SIDS being a diagnosis of exclusion that requires a PMSS, almost 10% of pathologists do not order a PMSS. Future research is necessary to reduce barriers to this important component of the pediatric forensic autopsy.
