Hata K, Funayama M, Tokudome S, Morita M
Department of Forensic Medicine, Sapporo Medical University School of Medicine, Japan.
Acta Paediatr Jpn. 1997 Oct;39(5):559-65. doi: 10.1111/j.1442-200x.1997.tb03641.x.
Various autopsy cases of sudden unexpected death (SUD) in infancy were examined at the Tokyo Medical Examiner's Office between 1985 and 1994. More than half of the SUD were diagnosed as sudden infant death syndrome (SIDS), but a number of other causes, such as mechanical asphyxia, were also diagnosed. SIDS is diagnosed by autopsy, but there are no clear diagnostic criteria differentiating SIDS from other causes of SUD. SUD is diagnosed as SIDS when other causes are excluded, but it is difficult to distinguish between SIDS and mechanical asphyxia. There was not a large difference in autopsy findings, or in death scene or statistical data, between SIDS and non-SIDS cases. In their estimation of the diagnostic ratio of SIDS to other causes of death, medical examiners might be divided into three groups: 'SIDS tolerationist' examiners think that SUD should be positively diagnosed as SIDS, insofar as another cause of death is not proved clearly. A second group of examiners might be regarded as 'SIDS exclusionist': these consider microscopic findings or peculiar death scenes as important contributing factors leading to death. The third group represents a middle stance somewhere between these two. We thought that (forensic) pathologists as well as medical examiners in Japan might have differing stances on SIDS diagnosis. The statistical analysis of SIDS in certain research areas may be affected by the diagnostic 'preference' of pathologists belonging to a certain institute.
1985年至1994年间，东京验尸官办公室对多例婴儿意外猝死（SUD）的尸检病例进行了检查。超过半数的SUD被诊断为婴儿猝死综合征（SIDS），但也诊断出了一些其他病因，如机械性窒息。SIDS通过尸检诊断，但尚无明确的诊断标准来区分SIDS与其他SUD病因。当排除其他病因时，SUD被诊断为SIDS，但很难区分SIDS与机械性窒息。SIDS病例与非SIDS病例在尸检结果、死亡现场或统计数据方面没有太大差异。在对SIDS与其他死因的诊断比例评估上，法医可能分为三组：“SIDS宽容派”法医认为，只要没有明确证明存在其他死因，SUD就应确诊为SIDS。第二组法医可被视为“SIDS排除派”：他们将微观检查结果或特殊的死亡现场视为导致死亡的重要因素。第三组则处于这两者之间的中间立场。我们认为，日本的（法医）病理学家和法医在SIDS诊断上可能存在不同立场。某些研究领域中SIDS的统计分析可能会受到某个机构病理学家诊断“偏好”的影响。
