Protocols, practices, and needs for investigating sudden unexpected infant deaths.

Area of Science:

• Forensic Pathology
• Public Health
• Pediatric Medicine

Background:

• Accurate cause-of-death certification is crucial for understanding mortality patterns.
• Sudden unexpected infant death (SUID) presents unique challenges in investigation and certification.
• Medical Examiner and Coroner (MEC) offices play a vital role in SUID investigations.

Purpose of the Study:

• To assess current case identification practices and protocols used by MECs for SUID investigations.
• To identify training and resource needs among MECs regarding SUID certification.
• To inform strategies for improving the accuracy and consistency of SUID cause-of-death certification.

Main Methods:

• A U.S.-representative survey of medical examiners and coroners (MEC).
• Data collection on investigation practices, use of standardized forms, and scene investigation techniques.
• Analysis of reported training needs and resource availability.

Main Results:

• High adoption of SUID Investigation Reporting Forms in large (89%) and medium (87%) jurisdictions, but lower in small (52%) ones.
• Routine completion of key infant death investigation elements (medical history, interviews, autopsy) was high (≥80%).
• Significant variation in scene re-creation practices and reported training needs (70% of MECs).

Conclusions:

• Standardized investigation protocols and increased training for MECs are essential for improving SUID cause-of-death certification.
• Addressing practice variations across different jurisdictional sizes can enhance data quality.
• Improved certification accuracy will lead to a better understanding of SUID epidemiology and prevention strategies.