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Yield of Postmortem Skeletal Surveys in Infants Presenting to Emergency Care With Sudden and Unexpected Death
M Katherine Henry, Teniola I Egbe1, Ammie M White
1Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Postmortem skeletal surveys (PM-SS) in sudden unexpected infant death (SUID) cases identified fractures in 8.2% of infants. This highlights the importance of PM-SS in evaluating potential child abuse in SUID.
Area of Science:
- Pediatrics
- Forensic Pathology
- Radiology
Background:
- Child abuse is a critical consideration in sudden unexpected infant death (SUID).
- Postmortem skeletal surveys (PM-SS) are recommended for detecting abusive fractures in SUID.
- Limited data exist on the diagnostic yield of PM-SS in infants presenting to emergency departments with SUID.
Purpose of the Study:
- To describe the clinical presentation and emergency care of infants with SUID.
- To report the utilization and findings of postmortem skeletal surveys (PM-SS) in SUID cases.
Main Methods:
- Retrospective study of infants (<12 months) with SUID at a tertiary children's hospital (2007-2019).
- Analysis of clinical presentation, emergency care, PM-SS performance, medical examiner referrals, and child protective services (CPS) reports.
- Assessment of associations between demographics/presentation and CPS reporting.
Main Results:
- All 73 SUID infants underwent PM-SS; 8.2% had definite or possible fractures (ribs, classic metaphyseal lesions).
- Cardiopulmonary resuscitation was performed in 97.3% of infants.
- 58.9% of cases were reported to CPS, with no demographic or clinical associations found.
Conclusions:
- Plain radiography identified fractures in approximately 1 in 12 SUID cases.
- Further multicenter research is necessary to compare imaging modalities and evaluate diverse populations.
Objectives:
Child abuse should be considered in cases of sudden unexpected infant death (SUID). Postmortem skeletal surveys (PM-SS) are recommended to evaluate for abusive fractures in SUID. Little is known about the yield of PM-SS among infants presenting to emergency care with SUID. Our objectives were to (1) describe the presentation and care of infants with SUID at a tertiary children's hospital emergency department and (2) report PM-SS use and findings.
Methods:
We performed a retrospective study of infants younger than 12 months with SUID presenting to an urban emergency department from 2007 to 2019. We describe their presentation and care, including PM-SS performance and findings, referrals to the medical examiner, and reports to child protective services (CPS). We assessed for associations between race, payer, and presentation with reports to CPS.
Results:
Of 73 infants with SUID, concern for unsafe sleep was documented in 45 (61.6%) and 71 (97.3%) underwent cardiopulmonary resuscitation by a medical professional. All 73 (100%) underwent PM-SS and were referred to the medical examiner. Twelve definite fractures (11 rib, 1 classic metaphyseal lesion) and 8 possible fractures (7 rib, 1 classic metaphyseal lesion) were identified among 6 (8.2%) infants. Forty-three (58.9%) were reported to CPS. There were no associations between race, payer, age, or history of unsafe sleep and CPS reports.
Conclusions:
One in 12 cases of SUID had a possible and/or definite fracture identified on plain radiography. Multicenter studies are needed to compare yield across different postmortem imaging modalities and populations.
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