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Current Practices in Postmortem Investigation of Sudden Unexpected Death in Infancy
Mathilde Ducloyer1,2, Karine Levieux3, Caroline Rambaud4
1Department of Forensic Medicine, Nantes University Hospital, Nantes, France.
Insights
Postmortem investigations for sudden unexpected death in infancy (SUDI) cases in France show increased use of certain tests but poor adherence to national guidelines. Improved protocols are needed for better diagnostic approaches in SUDI cases.
Area of Science:
- Forensic Pathology
- Pediatric Pathology
- Public Health
Background:
- Sudden unexpected death in infancy (SUDI) remains a significant concern.
- Standardized postmortem investigations are crucial for determining the cause of death.
- Compliance with national guidelines ensures thoroughness and consistency in SUDI case evaluations.
Purpose of the Study:
- To evaluate the current practices of postmortem investigations in sudden unexpected death in infancy (SUDI) cases in France.
- To analyze temporal trends in these investigations from 2015 to 2024.
- To assess the adherence of performed investigations to French National Health Authority guidelines.
Main Methods:
- Retrospective analysis of 1,934 SUDI cases from the French SUDI registry (2015-2024).
- Description and temporal trend analysis of postmortem investigations performed.
- Assessment of compliance with minimum non-invasive postmortem investigation sets for detecting unnatural death, including fundus examinations, imaging, and toxicology.
Main Results:
- Laboratory tests were most frequent (93.0%), while fundus examinations were least frequent (21.6%).
- Significant increases observed in fundus examinations, laboratory tests, bacteriological tests, toxicological tests, and whole-body imaging between 2015 and 2024.
- Only 2.1% of cases met strict French guidelines; 13.2% had minimal non-invasive investigations for detecting unnatural death.
Conclusions:
- While the frequency of certain postmortem investigations has increased, overall adherence to French guidelines remains low.
- There is a need for enhanced local protocols and updated guidelines to ensure comprehensive postmortem investigations in SUDI cases.
- Improving investigation protocols can lead to a more accurate diagnostic approach for sudden unexpected death in infancy.
Aim:
To assess postmortem investigations performed in sudden unexpected death in infancy (SUDI) cases in daily practice in France.
Methods:
Children deceased from SUDI and registered in the French SUDI registry from 2015 to 2024 were included retrospectively. The postmortem investigations performed in SUDI cases were described, their temporal trends since 2015 and their compliance with the French National Health Authority guidelines were assessed. The minimum set of non-invasive postmortem investigations performed in cases required to detect unnatural death, including fundus examinations, imaging and toxicological tests, was studied.
Results:
We examined 1 934 SUDI cases. Laboratory tests were the most frequently performed procedures (93.0%), and fundus examinations were the least frequent (21.6%). There was a significant increase in fundus examinations (9.3% to 31.6%), laboratory tests (87.6% to 97.3%), bacteriological tests (91.4% to 97.2%), toxicological tests (79.0% to 91.0%), and whole-body imaging (75.2% to 87.3%) from 2015 to 2024. Only 2.1% of cases were investigated strictly according to the French guidelines. We found that 13.2% of cases underwent minimal non-invasive postmortem investigation for detecting unnatural death.
Conclusion:
Although certain investigations are performed more frequently, efforts to improve local protocols and updated guidelines are needed to ensure thorough postmortem investigations, resulting in an improved diagnostic approach.
