Inaccurate classification of the cause and manner of infant deaths impedes prevention efforts by limiting researchers' ability to accurately identify risk factors for SIDS and other sudden, unexpected deaths in infancy (SUDI). Sheehan and colleagues1 present evidence of inaccurate reporting of SIDS in Ireland and underscore the necessity for standardised SUDI criteria and definitions, as well as a multidisciplinary approach to improve the diagnostic reliability of SUDI cases. Two recent US studies also provide evidence that cause‐of‐death reporting for SUDI may be unreliable by demonstrating that the decline in the SIDS rate since 1999 is offset by increasing mortality rates for cause unknown/unspecified and accidental suffocation and strangulation in bed.2,3
We agree with Sheehan and colleagues' approach for improving the accuracy of SUDI reporting.1 In addition, we believe it is imperative that a thorough death scene investigation be conducted before a death can be classified as SIDS. Studies have presented evidence to support the contention that SIDS and other SUDI are more accurately diagnosed when information from a death scene investigation is used to make the diagnosis.4,5 A thorough infant death scene investigation should at a minimum include interviewing witnesses, examining the death scene, staging a doll reenactment, reviewing medical history, and carefully assessing the infant's exposures prior to death.
To improve the accuracy and consistency with which SUDI are classified, the Centers for Disease Control and Prevention (CDC) is leading a US effort to develop standards for the conduct of infant death scene investigations. We are developing training curricula and materials to instruct those investigating and certifying infant deaths on how to gather information at the scene and use the data to interpret postmortem examination findings. This training will help ensure that accurate and consistent diagnoses of SIDS and SUDI are made.
Footnotes
Competing interests: none declared
References
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