Skip to main content
SpringerLink
Log in

Reclassification of SIDS cases—a need for adjustment of the San Diego classification?

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

A study was undertaken reclassifying cases of sudden infant death syndrome (SIDS) taken from two geographically separate locations utilizing the San Diego definition with subclassifications. One hundred twenty-eight infant cases were examined from files at Forensic Science South Australia in Adelaide, SA, Australia over a 7.5-year period from July 1999 to January 2007. Thirty-one cases (24%) had initially been diagnosed as SIDS and 30 (23%) as undetermined while 67 (52%) had an explainable cause of death. After reclassification, the number of SIDS cases had increased to 49 of the 128 cases, now representing 38% of the cases; category IB SIDS constituted 10 (20%) and II SIDS 39 (80%) of the SIDS cases. No cases were classified as IA SIDS. Two hundred eighteen infant cases were identified from the files of the Department of Forensic Medicine, Aarhus University, Denmark over a 16-year period from 1992 to 2007. Eighty-two (38%) were originally diagnosed as SIDS, 128 (59%) with identifiable causes of death, and 8 (4%) as unexplained. After review, 77 (35%) cases were reclassified as SIDS, a decrease of 6%. Twenty (26%) infants were classified as category IB SIDS and 57 (74%) as II SIDS. None of the cases met the criteria for IA SIDS. Problems arose in assessing cases with failure to thrive, fever, and possible asphyxia. Modifications to the San Diego subclassifications might improve the consistency of categorizing these cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T et al (2004) Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics 114:234–238

    Article  PubMed  Google Scholar 

  2. Beckwith JB (1970) Discussion of terminology and definition of the sudden infant death syndrome. In: Bergman AB, Beckwith JB, Ray CG (eds) Sudden infant death syndrome: proceedings of the second international conference on causes of sudden death in infants. University of Washington Press, Seattle, pp 14–22

    Google Scholar 

  3. Willinger M, James LS, Catz C (1991) Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatr Pathol 11:677–684

    Article  PubMed  CAS  Google Scholar 

  4. Cordner SM, Willinger M (1995) The definition of the sudden infant death syndrome. In: Rognum TO (ed) Sudden infant death syndrome: new trends in the nineties. Scandinavian University Press, Oslo, pp 17–20

    Google Scholar 

  5. Rambaud C, Guilleminault C, Campbell PE (1994) Definition of the sudden infant death syndrome. BMJ 308:1439

    Article  PubMed  CAS  Google Scholar 

  6. Beckwith JB (2003) Defining the sudden infant death syndrome. Arch Pediatr Adolesc Med 157:286–290

    PubMed  Google Scholar 

  7. Gregersen M, Rajs J, Laursen H, Baandrup U, Frederiksen P, Gidlund E et al (1995) Pathologic criteria for the Nordic study of SIDS. In: Rognum TO (ed) Sudden infant death syndrome: new trends in the nineties. Scandinavian University Press, Oslo, pp 50–58

    Google Scholar 

  8. L'Hoir MP, Engelberts AC, van Well GT, Bajanowski T, Helweg-Larsen K, Huber J (1998) Sudden unexpected death in infancy: epidemiologically determined risk factors related to pathological classification. Acta Paediatr 87:1279–1287

    Article  PubMed  Google Scholar 

  9. Gilbert R, Rudd P, Berry PJ, Fleming PJ, Hall E, White DG et al (1992) Combined effect of infection and heavy wrapping on the risk of sudden unexpected infant death. Arch Dis Child 67:171–177

    Article  PubMed  CAS  Google Scholar 

  10. Byard RW, Marshall D (2007) An audit of the use of definitions of sudden infant death syndrome (SIDS). J Forensic Leg Med 14:453–455

    Article  PubMed  Google Scholar 

  11. Byard RW, Jensen LL (2008) Is SIDS still a ‘diagnosis’ in search of a disease? Aust J Forensic Sci 40:85–92

    Article  Google Scholar 

  12. Tursz A, Crost M, Gerbouin-Rérolle P, Cook JM (2010) Underascertainment of child abuse fatalities in France: retrospective analysis of judicial data to assess underreporting of infant homicides in mortality statistics. Child Abuse Negl 34:534–544

    Article  Google Scholar 

  13. Byard RW (2010) Sudden unexpected death in infancy (SUDI)—the role of the pathologist. Curr Pediatr Rev 6:21–26

    Article  Google Scholar 

  14. Byard RW, Cohle SD (1994) Australasian autopsy protocol. Sudden death in infancy, childhood and adolescence, 1st edn. Cambridge University Press, Cambridge

    Google Scholar 

  15. Vege A, Rognum TO, Løberg EM, Isaksen CV, Morild I, Jørgensen L et al (1995) Diagnosis of sudden infant death in the Nordic countries since 1970, revised (1995). In: Rognum TO (ed) Sudden infant death syndrome: new trends in the nineties. Scandinavian University Press, Oslo, pp 67–69

    Google Scholar 

  16. Shirley ED, Ain MC (2009) Achondroplasia: manifestations and treatment. J Am Acad Orthop Surg 17:231–241

    PubMed  Google Scholar 

  17. Bajanowski T, Vege A, Byard RW, Krous HF, Arnestad M, Bachs L et al (2007) Sudden infant death syndrome (SIDS)—Standardised investigations and classification: recommendations. Forensic Sci Int 165:129–143

    Article  PubMed  Google Scholar 

  18. Byard RW, Krous HF (1995) Minor inflammatory lesions and sudden infant death: cause, coincidence, or epiphenomena? Pediatr Pathol Lab Med 15:649–654

    PubMed  CAS  Google Scholar 

  19. Loberg EM, Naess AB (1991) Is the increased frequency of sudden infant death caused by changed diagnostic criteria? Tidsskr Nor Laegeforen 111:2864–2866

    PubMed  CAS  Google Scholar 

  20. Rognum TO (1996) SIDS or not SIDS? Classification problems of sudden infant death syndrome. Acta Paediatr 85:401–403

    Article  PubMed  CAS  Google Scholar 

  21. Hatton F, Bouvier-Colle MH, Barois A, Imbert MC, Leroyer A, Bouvier S et al (1995) Autopsies of sudden infant death syndrome—classification and epidemiology. Acta Paediatr 84:1366–1371

    Article  PubMed  CAS  Google Scholar 

  22. Fleming PJ, Blair PS, Sidebotham PD, Hayler T (2004) Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families: an integrated multiagency approach. BMJ 328:331–334

    Article  PubMed  Google Scholar 

  23. Blair PS, Byard RW, Fleming PJ (2009) Proposal for an international classification of SUDI. Scand J Forensic Sci 15:6–9

    Google Scholar 

  24. Byard RW (2009) The value of death scene investigation in the recognition of unsafe sleeping conditions in the young. Aust J Forensic Sci 41:147–153

    Article  Google Scholar 

  25. Bajanowski T, Brinkmann B, Vennemann M (2006) The San Diego definition of SIDS: practical application and comparison with the GeSID classification. Int J Legal Med 120:331–336

    Article  PubMed  CAS  Google Scholar 

  26. Ingham AI, Langlois NE, Byard RW (2011) The significance of bruising in infants—a forensic postmortem study. Arch Dis Child 96:118–120

    Article  Google Scholar 

  27. Connell-Carrick K, Scannapieco M (2006) Ecological correlates of neglect in infants and toddlers. J Interpers Violence 21:299–316

    Article  PubMed  Google Scholar 

  28. Colvin JM, Jaffe DM, Muenzer JT (2011) Evaluation of the precision of emergency department diagnoses in young children with fever. Clin Pediatr. doi:10.1177/0009922811417295

Download references

Acknowledgments

This study was funded by SIDS and Kids SA, Australia.

Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Aarhus University, Brendstrupgaardsvej 100, Aarhus N, DK-8200, Aarhus, Denmark

    Lisbeth Lund Jensen, Marianne Cathrine Rohde & Jytte Banner

  2. Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia

    Lisbeth Lund Jensen & Roger William Byard

  3. Forensic Science SA, Adelaide, SA, Australia

    Lisbeth Lund Jensen & Roger William Byard

Authors
  1. Lisbeth Lund Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marianne Cathrine Rohde
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jytte Banner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roger William Byard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisbeth Lund Jensen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jensen, L.L., Rohde, M.C., Banner, J. et al. Reclassification of SIDS cases—a need for adjustment of the San Diego classification?. Int J Legal Med 126, 271–277 (2012). https://doi.org/10.1007/s00414-011-0624-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-011-0624-z

Keywords

Search

Navigation