trends in sudden unexplained infant deaths (suids) and the impact of medical examiner reporting,...

Trends in Sudden Unexplained Infant Deaths (SUIDs) and the Impact of Medical Examiner

Reporting, Florida 1990-2005

Angel Watson, MPH, RHIA William M. Sappenfield, MD, MPH Florida Department of HealthDivision of Family Health Services Office of Surveillance, Evaluation and Epidemiology December 2007

AcknowledgementsMichael L. Haney, PhD, NCC, CCISM, LMHC

Ken Jones, Deputy State Register

Gary J. Sammet, Senior Management Analyst Supervisor

Dave Goodman, PhD, MS

Daniel R. Thompson, MPH

Susan Potts, LCSW

DefinitionsSIDS is the sudden death of aninfant under one year of age whichremains unexplained after athorough case investigation, including performance of acomplete autopsy, examination ofthe death scene, and review of theclinical history.

(Willinger et al, 1991)(Cause of Death—ICD-9: 798.0, ICD-10: R95)

SUIDs is the sudden death of an infant under one year of age that is unexplained at the time of death. Includes: sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed (ASSB), other accidental suffocation and strangulation (OASS), neglect, abandonment, and other maltreatment syndrome and cause unknown/unspecified.

(Shapiro-Mendoza, et al 2006)

Sudden Infant Death Syndrome (SIDS)

Leading cause of SUIDs related deaths

Pathophysiology is unknown

Occurs mostly among infants 1 to 6 months

Approximately 2,500 case per year in U.S.

Third leading cause of infant death, until 2004

Source: National Center on Health Statistics (NCHS), 2000

SIDS, Florida Statues, Chapter 383

The medical examiner must perform an autopsy upon any infant under the age of 1 year who is suspected to have died of Sudden Infant Death Syndrome.

The Medical Examiners Commission shall develop and implement a protocol for dealing with suspected sudden infant death syndrome. The protocol must be followed by all medical examiners when conducting the autopsies required under this subsection.

Source: Florida Statues, Fla. Stat. Ann. § 383.3362

Background

Infant Mortality Rates for Florida and the United States, 1990-2005

0

2

4

6

8

10

1990 1995 2000 2005

Rat

e pe

r 10

0,00

0 Li

ve B

irth

s

FL US

Florida, 1990 to 2005

Infant mortality rate decreased 25%.

Prevalence of Sudden Infant Death Syndrome (SIDS) deaths declined 65%.

Prevalence of other Sudden Unexpected Infant Deaths (SUIDs) increased 205%.

Study Purpose

How has reporting of SIDS, cause unknown/unspecified and other SUIDs changed over time in Florida? How have these trends varied over time by Medical Examiner districts?

MethodsDeath certificates from 1998 to 2005 were used to examine trends.

Deaths were grouped into the state’s 24 medical examiner districts.

Cause-specific mortality proportions were estimated using the categories proposed by Shapiro-Mendoza.

Deaths by cause were limited to SIDS, causes unknown/unspecified and other SUIDs.

Deaths due to abuse, neglect, and other maltreatment were excluded.

Results

Sudden Infant Death Syndrome (SIDS)(ICD-10 code: R95), Florida, 2006

Causes DescriptionsInfant Death while co-sleeping between mother and sister

Unexpected Death of infant while sleeping with parent and sibling in twin size bed

Sudden Unexplained Infant DeathProne Sleeping position; Undetermined whether external causes involved; Co-sleeping with adults

Sudden Infant Death Syndrome History of co-sleeping and prone sleeping position

Sudden Unexpected Death in infancy While co-sleeping with sibling and adult

Consistent with Sudden Infant Death Syndrome

Co-sleeping with adult and older sibling; Face down on sofa

Consistent with the definition of SIDSUnknown whether external causes contributed to death

Sudden infant death syndrome associated with co-sleeping

Prematurity (36 weeks), IUGR (symmetric), cleft soft palate

Sudden infant death while co-sleepingThe decedent was found unresponsive while co-sleeping

Sudden infant death while co-sleeping with parent

Premature infant died while sleeping with mother on couch

Data Source: Florida Department of Health , Office of Planning, Evaluation and Data Analysis, Vital Statistics

Accidental suffocation and strangulation in bed (ICD-10 code: W75), Florida, 2005

Causes Descriptions

Suffocation Co-sleeping with others

Probable Asphyxia with overlay Co-sleeping with adults

Positional Asphyxia Decedent face down on pillow

Mechanical Asphyxia Mother fell asleep over baby

Possible Overlay Co-sleeping with others

Anoxic encephalopathy Co-sleeping with others with soft bedding

Asphyxia due to suffocation Found face down in bed

Suffocation; Occlusion of nose and mouth and compression of torso Overlay of adult caregiver during sleep

Mechanical compression of head and torso Overlay during co-sleep

Mechanical suffocation by blanket Head wrapped by blanket in playpen


Other specified/unspecified threats to breathing (ICD-10 codes: W83 & W84), Florida, 2005

Causes Descriptions

Positional Asphyxia Fell off bed into clothes

Probable Asphyxia Co-sleeping with other children

Positional Asphyxia Fell face first onto bedding

Suffocation Found between cushions

Asphyxia Deceased asphyxiated during sleep due to positioning

Positional Asphyxia Positioned head between mattress and play pen wall

Asphyxia Deceased inadvertently asphyxiated during sleep


Unknown/Unspecified (ICD-10 codes: R99), Florida, 2005

Causes Descriptions

Undetermined after complete autopsy

Undetermined Found unresponsive while sleeping

Undetermined Bed Sharing

Presumed Natural Causes

Undetermined Could not be determined

Termination due to potentially fatal maternal cardiac indications

Pending Unknown


Selected Causes of Infant Mortality Trends, Florida 1992-2005

0

20

40

60

80

100

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Rat

e p

er 1

00,0

00 L

ive

Bir

ths

SIDS Cause Unknown/Unspecified

Accidental Suffocation & Strangulation in Bed Other Accidental Suffocation & Strangulation

Neglect, Abandonment, & Other Maltreatment Syndromes

Data Source: Florida Department of Health , Office of Planning, Evaluation and Data Analysis

Selected Causes of Infant Mortality Trends, Florida 1992-2005

0

20

40

60

80

100

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Rat

e p

er 1

00,0

00 L

ive

Bir

ths

SIDS Cause Unknown/Unspecified

Accidental Suffocation & Strangulation in Bed Other Accidental Suffocation & Strangulation

Neglect, Abandonment, & Other Maltreatment Syndromes Cause Unknown/Unspecified and SUID

Data Source: Florida Department of Health , Office of Planning, Evaluation and Data Analysis

Data Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis

Percent of Selected SUIDs by Medical Examiner District, Florida 2002-2005

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

A B C D E F G H I J K L M N O P Q R S T U V W X

Medical Examiner District

SIDS CUU Comb. ASSB

Group 1

Group 2

Group 3

Group 4

Average Percent of Selected Causes of Death for Medical Examiner Groups, Florida 2002-2005

54%

17%

30%

59%

31%

10%

17%

28%26%

53%

21%

55%

0%

20%

40%

60%

80%

SIDS CUU ASSB & OASS

Group 1 Group 2 Group 3 Group 4

Data Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis

Average Percent of Selected Causes of Death for Medical Examiner Groups, Florida

0%

20%

40%

60%

80%

100%

SIDS CUU ASSB &OASS

SIDS CUU ASSB &OASS


1990-1993 2002-2005Data Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis

Average Percent of Selected Causes of Death for Medical Examiner Groups, Florida 1990-2005

0%

20%

40%

60%

80%

100%

SIDS CUU ASSB& OASS

SIDS CUU ASSB& OASS

SIDS CUU ASSB &OASS

SIDS CUU ASSB &OASS


1990-1993 1994-1997 1998-2001 2002-2005Data Source: Florida Department of Health, Office of Planning, Evaluation and Data Analysis

ConclusionsAlthough SIDS rates have declined, the state SUIDs rates have not improved since 1998. This may be attributed to the shifting of reporting to different cause groups.

Trends suggest varied changes in reporting by medical examiner districts rather than a uniform change in statewide reporting.

Public Health Implications

Differences in reporting especially unknowns make it difficult for communities to assess, implement, and evaluate prevention strategies.

Recommendations

Florida medical examiners should consider developing consistent SUIDs investigation and reporting guidelines.

SUIDI Reporting Form

• In March 2006, CDC released the SUIDI reporting form for state and local use in infant death scene investigations. This form replaced the investigation report form that accompanied the 1996 Guidelines for the death scene investigation of SUIDs.

Source: The Centers for Disease Control and Prevention

Thank YouContact Information:

Angel Watson, MPH, RHIAResearch Scientist, Division of Family Health Services

William M. Sappenfield, MD, MPHState MCH Epidemiologist, Division of Family Health Services

Florida Department of Health4052 Bald Cypress Way, Bin A 13 (Mail)4025 Esplanade Way, Room 130G (Location)Tallahassee, FL 32399-1721

Phone: 850-245-4100Fax: 850-414-6091Email: [email protected]: [email protected]

Supplemental Graphs

Medical Examiner Cause of Death PatternsGroup 1

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

2002-2005 SIDS % of Deaths 2002-2005 CUU % of Deaths 2002-2005 ASSB % of Deaths

Group 2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0


Group 3

0.0

2.0

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6.0

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12.0

14.0

16.0

18.0


Group 4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0


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