Arnestad Marianne, Vege Ashild, Rognum Torleiv Ole
Institute of Forensic Medicine, University of Oslo, Rikshospitalet, 0027, Norway.
Forensic Sci Int. 2002 Feb 18;125(2-3):262-8. doi: 10.1016/s0379-0738(02)00009-9.
During the period between 1984 and 1999, 309 cases of sudden unexpected death in infancy and early childhood (0-3 years) were investigated at the Institute of Forensic Medicine in Oslo. In 73 cases, an explainable cause of death was found. In this non-sudden infant death syndrome (SIDS) group, 42 cases were due to disease, 14 to accidents, 7 to neglect/abuse and 10 cases were due to homicide. In 43 cases, there were pathological findings at the autopsy or suspect features in the history and/or circumstances, which were, however, insufficient to explain death ("borderline" SIDS). In the remaining 193 cases, nothing of significance was detected ("pure" SIDS). The purpose of the present study was to evaluate the importance of the different diagnostic tools used in diagnosing non-SIDS and borderline SIDS cases. The definition of SIDS requires a negative history as well as a negative autopsy result. Thus, the following variables were analysed: circumstances, medical history and autopsy, which included a gross pathological investigation, histology, neuropathology, microbiology, radiology and toxicology. In diagnosing deaths due to disease, histology, neuropathology and microbiology were the most important diagnostic tools. In contrast, information about the circumstances of death and the gross pathological findings at autopsy most often revealed the cause of death in accidents and cases of neglect/abuse and homicide. Following the drop in SIDS rate in Norway after 1989, the share of pure SIDS in proportion to the total population of sudden unexpected deaths in infancy and early childhood has decreased. The increasing proportion of non-SIDS and borderline SIDS cases presents a challenge to improve the quality of the investigation in cases of sudden death in infancy and early childhood.
1984年至1999年期间，奥斯陆法医学研究所对309例婴儿期和幼儿期（0至3岁）意外猝死病例进行了调查。在73例病例中，发现了可解释的死亡原因。在这个非婴儿猝死综合征（SIDS）组中，42例死于疾病，14例死于意外事故，7例死于忽视/虐待，10例死于他杀。在43例病例中，尸检有病理发现或病史和/或情况中有可疑特征，但不足以解释死亡原因（“临界”SIDS）。在其余193例病例中，未检测到任何有意义的情况（“单纯”SIDS）。本研究的目的是评估用于诊断非SIDS和临界SIDS病例的不同诊断工具的重要性。SIDS的定义要求病史阴性以及尸检结果阴性。因此，对以下变量进行了分析：情况、病史和尸检，其中包括大体病理学检查、组织学、神经病理学、微生物学、放射学和毒理学。在诊断疾病导致的死亡时，组织学、神经病理学和微生物学是最重要的诊断工具。相比之下，关于死亡情况的信息和尸检时的大体病理发现最常揭示意外事故、忽视/虐待和他杀案件的死亡原因。1989年后挪威SIDS率下降后，单纯SIDS在婴儿期和幼儿期意外猝死总人口中所占比例有所下降。非SIDS和临界SIDS病例比例的增加对提高婴儿期和幼儿期猝死病例调查质量提出了挑战。
