Shields Lisa B E, Hunsaker John C, Corey Tracey S, Stewart Donna
Office of the Associate Chief Medical Examiner, Frankfort, Kentucky, USA.
J Ky Med Assoc. 2007 Aug;105(8):343-53.
Sudden Infant Death Syndrome (SIDS) is defined as a diagnosis of exclusion, after an evaluation of the medical history, complete postmortem examination, and scene investigation. The diagnosis of SIDS in many sudden and unexplained infant deaths has not been consistently applied nationally or, prior to July 2003, in the state of Kentucky. In order to better standardize practices in formulating the diagnosis of SIDS in cases of sudden and unexpected infant deaths, all of the Kentucky medical examiners formed a working group to collectively standardize the classification of this enigmatic type of infant death.
We conducted a retrospective review (2000-2004) of infants < 1 year who underwent complete historical review, circumstantial investigation, postmortem examination, and toxicological analysis performed at the Medical Examiners' Offices in Kentucky encompassing all deaths certified as Sudden Infant Death Syndrome, positional asphyxia, overlay, and undetermined cause and manner of death.
A total of 417 cases were deemed sudden unexplained infant deaths after postmortem examination at the Medical Examiners' Offices in Kentucky between 2000 and 2004. A total of 237 (56.8%) infants had been bedsharing with at least one other person when found. Prior to the SIDS classification policy change in July 2003, a significantly greater number of sudden unexpected infant death cases were deemed undetermined in both cause and manner in contrast to a smaller number classified as SIDS. After the policy change, the number of deaths classified as SIDS greatly surpassed the number classified as undetermined.
The increase in the number of deaths consistent with SIDS and a reciprocal decline in cases reported as undetermined cause and manner of death in Kentucky is due to the uniformity and standardization of terminology, rather than an actual increase in the number of infant deaths. The Kentucky policy in July 2003 has been invaluable in ensuring uniform criteria in the diagnosis of SIDS and other categories of sudden unexpected death in infants < 1 year.
婴儿猝死综合征（SIDS）被定义为在对病史、完整的尸体解剖检查和现场调查进行评估后做出的排除性诊断。在许多婴儿突然不明原因死亡的案例中，SIDS的诊断在全国范围内以及在2003年7月之前的肯塔基州都没有得到一致应用。为了更好地规范在婴儿突然意外死亡病例中制定SIDS诊断的做法，肯塔基州所有的法医组成了一个工作组，共同规范这种神秘类型婴儿死亡的分类。
我们对2000年至2004年间在肯塔基州法医办公室接受完整病史回顾、情况调查、尸体解剖检查和毒理学分析的1岁以下婴儿进行了回顾性研究，这些婴儿的死亡被认证为婴儿猝死综合征、体位性窒息、窒息和死因及死亡方式不明。
2000年至2004年间，在肯塔基州法医办公室进行尸体解剖检查后，共有417例婴儿被判定为突然不明原因死亡。发现时，共有237例（56.8%）婴儿与至少一人同床。在2003年7月SIDS分类政策改变之前，与被归类为SIDS的较少数量病例相比，显著更多的婴儿突然意外死亡病例在死因和死亡方式上被判定为不明。政策改变后，被归类为SIDS的死亡数量大大超过了被归类为不明的数量。
肯塔基州符合SIDS的死亡数量增加以及报告为死因和死亡方式不明的病例相应减少，是由于术语的统一和标准化，而不是婴儿死亡数量的实际增加。2003年7月的肯塔基州政策对于确保1岁以下婴儿SIDS和其他类别突然意外死亡的诊断标准统一非常宝贵。
