Advocating for Comprehensive Investigations
Determining the cause and manner of death when an infant or young child dies suddenly and unexpectedly requires a thorough investigation. This must include: examination of the scene where the infant/child died, performance of a complete autopsy, and a review of the child’s and family’s medical history.
Comprehensive and standardized investigations provide a framework whereby the most accurate diagnoses can be attained, health statistics can be improved, research can be directed and resources can be guided where the need is greatest. Providing comprehensive investigations is in the best interest of all parties- the medicolegal professions, law enforcement, the medical community, public health, the lay community and the individual families who are faced with the tragedy of losing a child in this sudden unexpected manner.
Throughout the U.S, individual state systems vary in their approach to death investigations. Some jurisdictions have Medical Examiner systems, some are directed by Coroner systems, and others operate under some combination of the two. Nearly every state has a statute requiring that a death investigation occur in cases of sudden unexpected death. However the actual performance of each aspect of the investigation may be discretionary. For example, a scene investigation may not always occur or an autopsy may not be performed in all cases. Contacting your state legislator will help you find out what occurs in your state.
Over 15 years ago, California paved the way for many by creating specific statutes that mandate standards when investigating sudden infant death. Recently some states, such as Arizona, Washington and New Jersey, have passed new legislation. They include mandates for the use of autopsy protocols, standards for scene investigation, and in NJ allow for the use of pediatric pathologists for consultation.
In 1996, the CDC created a standardized set of guidelines for use when investigating the scenes of unexpected infant deaths and has now revised them in 2006. Information on these guidelines can be found at http://www.cdc.gov/SIDS/SUIDHowtoUseForm.htm
Standardized autopsy protocols in sudden unexpected infant death have also been created and endorsed by the National Association of Medical Examiners and Society for Pediatric Pathology.
Although the implementation of these protocols is far from universal, we do know that the value of information we have gained through their use has led to great strides in research and provided the basis for public awareness campaigns to reduce the risk of SIDS and improve safe sleeping environments for babies. Continuing to improve on the utilization of the most accurate information gained from each child’s death is crucial in reaching our ultimate goal of the prevention of such tragedies in our future.
Citations for the above noted protocols are:
Centers for Disease Control and Prevention (CDC). Guidelines for Death Scene Investigation of Sudden Unexplained Infant Deaths. Recommendations of the Interagency Panel on Sudden Infant Death Syndrome. Morbid Mort Week 1996;45:1-22.
Krous HF, Byard RW. International Standardized Autopsy protocol for sudden unexpected infant death. Appendix I. In: Sudden Infant Death Syndrome. Problems, Progress and Possibilities. Byard RW, Krous HF, Eds. London, Arnold. 2001, pp 319-333.
