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SUID investigation protocols inconsistent throughout US
Despite CDC guidelines for the investigation of sudden infant deaths, investigation and autopsy protocols varied widely among medical examiner and coroner jurisdictions within the United States, according to an article published in Pediatric Annals.
“The legal requirement to investigate an infant death may not be specifically referenced in all states’ statutes, but an infant who dies suddenly with no readily recognizable disease must be investigated by the medical examiner or coroner,” Roger A. Mitchell, Jr., MD, a chief medical examiner from the department of pathology at George Washington University, and colleagues wrote. “In the U.S., there are no national standards for the practice of medicolegal death investigation; however, there are national guidelines regarding the performance of death scene investigation.”
Typically, law enforcement and emergency services are dispatched to the scene upon discovering an unresponsive infant. Later, the medicolegal death investigator is required to initiate a prompt physical examination, including the documentation of livor mortis, and to perform a Sudden, Unexplained Infant Death Investigation Reporting Form (SUIDIRF).
The SUIDIRF includes questions that are to be asked of the parent(s) or caregiver. To establish rapport, the investigator should collect the child’s demographics and the interviewee’s contact information. It must be determined who put the infant to sleep and who found the infant unresponsive. If these people are different, the authors suggest conducting two separate interviews to avoid distraction.
Additional information collected includes date, time and location where the infant was last seen alive; placed and found positions; the infant’s medical and dietary histories; the mother’s pregnancy history; and any injuries sustained by the infant, which should be later described and demonstrated when investigating the incident location. Information on vaccinations, medication administration, known allergies, recent encounters with health care providers and birth history are also needed to complete this form.
When documenting the scene, information on the condition of the residence and sleep environments must be collected, and a doll reenactment must be completed. According to Mitchell and colleagues, this step is important because it helps to visualize head and neck position when placed and found, as well as to identify possible suffocation, wedging or overlay. The placer reenacts placing the infant to sleep and positions it in the same manner as the child. The finder then recreates the way in which the infant was found.
If stains are found on the bed, the investigator should photograph these. Following the reenactment and investigation, the investigator should ask the finder to explain and demonstrate the actions taken after finding the infant, which may include resuscitation efforts and handling.
“Such investigations have led to a diagnostic shift away from SIDS and toward SUID, unknown causes and accidental suffocation and strangulation,” the researchers wrote. “An ‘undetermined’ manner of death includes cases that, despite a complete autopsy and thorough investigation, remain uncertain about the true cause of death… Unexplained and undetermined cause and manner of death may be justified if the scene investigation or autopsy is incomplete.”– by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.