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Continuing major inconsistencies in the classification of unexpected infant deaths

Roger W Byard1, Rebecca A Shipstone2, Jeanine Young2

  • 1School of Medicine, The University of Adelaide and Forensic Science SA, Adelaide, SA, 5000, Australia.

Journal of Forensic and Legal Medicine
|March 22, 2019
PubMed

Insights

Inconsistent classification of unexpected infant deaths, including sudden infant death syndrome (SIDS), hinders accurate diagnosis. Clarifying definitions and using algorithms could improve distinctions between SIDS and other causes like suffocation.

Area of Science:

  • Forensic Pathology
  • Pediatric Medicine
  • Public Health

Background:

  • Classification of unexpected infant deaths is inconsistent among pathologists and researchers.
  • Current definitions, like the San Diego definition of SIDS, are not consistently applied.
  • Various terms such as SIDS, accidental suffocation, USID, and SUDI are used, leading to confusion.

Purpose of the Study:

  • To review the current challenges in classifying unexpected infant deaths.
  • To highlight the need for clearer definitions and diagnostic criteria.
  • To explore potential improvements in differentiating SIDS from other causes of infant mortality.

Main Methods:

  • Review of existing literature and classification systems for unexpected infant deaths.
  • Analysis of inconsistencies in the application of definitions like the San Diego SIDS definition.
  • Discussion of the impact of lacking diagnostic pathological markers.

Main Results:

  • Pathological markers for definitively diagnosing SIDS are absent.
  • Conflicting classification systems contribute to idiosyncratic certification practices.
  • Inconsistent application of definitions leads to variability in death certification.

Conclusions:

  • Clarifying 'mechanical asphyxia not determined with certainty' may help differentiate SIDS from USID.
  • Implementing a classification algorithm could better define unsafe sleep factors and suffocation.
  • Improved diagnostic criteria and consistent application are crucial for accurate infant death classification.

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