Takatsu A, Misawa S, Yoshioka N, Nakasono I, Sato Y, Kurihara K, Nishi K, Maeda H, Kurata T
Department of Forensic Medicine, Jikei University School of Medicine, Tokyo, Japan.
Nihon Hoigaku Zasshi. 2000 Aug;54(2):247-55.
There are many sudden unexpected infant death cases which are easily diagnosed as sudden infant death syndrome (SIDS) both with or without autopsy in Japan. A SIDS diagnosis may provide a cover for accidental or criminal death. SIDS should not be a convenient diagnostic box that shelters the cases of unexpected infant death which lack the necessary antemortem information to make the correct diagnosis. The authors consider that SIDS should be diagnosed according to the direction of the international definition of SIDS, and propose the following essentials for a forensic pathological diagnosis. 1) A thorough autopsy should be performed based on precise autopsy protocol, including not only histological observation, but also, if necessary, toxicological, bacteriological, viral and/or biochemical examinations. 2) The forensic pathologist should be provided with pertinent information regarding antemortem health status, past clinical history, social circumstances, death scene investigation, etc. In order to collect more precise information, the authors recommend using a questionnaire such as the example in this report to record information from the deceased's guardians. 3) Suspicion of accidental death or infanticide should be completely ruled out. SIDS should be diagnosed only after these three essentials have been satisfied. When there is even a slight suspicion of accidental death or infanticide, or when the forensic pathologist can not obtain pertinent information about the deceased, the causes and classification of the death should be diagnosed as unspecified or undetermined. That is, the causes and classification of the death are undetermined as to whether it is a natural or unnatural death. Furthermore, several warning flags indicating a possible SIDS diagnosis were proposed: a case found dead in a supine position, the existence of a foreign body in the respiratory tract or mild infectious findings. The authors also emphasize the physician's responsibility to report a case found dead or dying of unnatural or clinically unexplained causes to the police. This is the crucial first step in getting an accurate diagnosis of SIDS.
在日本，有许多意外突发的婴儿死亡案例，无论是否进行尸检，都很容易被诊断为婴儿猝死综合征（SIDS）。SIDS的诊断可能会掩盖意外死亡或刑事死亡的真相。SIDS不应成为一个方便的诊断框，用来掩盖那些缺乏做出正确诊断所需生前信息的意外婴儿死亡案例。作者认为，SIDS应根据国际上对SIDS的定义来诊断，并提出以下法医病理诊断要点。1）应根据精确的尸检方案进行全面的尸检，不仅包括组织学观察，还包括必要时的毒理学、细菌学、病毒学和/或生化检查。2）应向法医病理学家提供有关生前健康状况、既往临床病史、社会情况、死亡现场调查等相关信息。为了收集更精确的信息，作者建议使用本报告中的示例问卷来记录死者监护人提供的信息。3）应完全排除意外死亡或杀婴的嫌疑。只有在满足这三个要点后才能诊断为SIDS。当哪怕有轻微的意外死亡或杀婴嫌疑，或者当法医病理学家无法获得有关死者的相关信息时，死亡原因和分类应诊断为未明确或未确定。也就是说，死亡原因和分类无法确定是自然死亡还是非自然死亡。此外，还提出了几个可能提示SIDS诊断的警示信号：尸体仰卧位被发现、呼吸道存在异物或有轻微感染迹象。作者还强调医生有责任向警方报告非自然死亡或临床无法解释原因的死亡或濒死案例。这是准确诊断SIDS的关键第一步。
