trends in sudden unexplained infant deaths (suids) and the impact of medical examiner reporting,...
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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
Data Source: Florida Department of Health , Office of Planning, Evaluation and Data Analysis, Vital Statistics
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
Data Source: Florida Department of Health , Office of Planning, Evaluation and Data Analysis, Vital Statistics
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
Data Source: Florida Department of Health , Office of Planning, Evaluation and Data Analysis, Vital Statistics
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
Group 1 Group 2 Group 3 Group 4
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
Group 1 Group 2 Group 3 Group 4
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
2002-2005 SIDS % of Deaths 2002-2005 CUU % of Deaths 2002-2005 ASSB % of Deaths
Group 3
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 4
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