title: Postmortem skeletal survey practice in pediatric forensic autopsies: a national survey.
abstract: Recommendations for the evaluation of an unexplained death in infancy include a postmortem skeletal survey (PMSS) to exclude skeletal trauma. Objectives of this study were to assess adherence to these recommendations in forensic autopsies in children equal to or less than 36 months of age, and what factors influence the use or nonuse of the PMSS. We surveyed pathologists who were members of the American Academy of Forensic Sciences. The survey included practice characteristics about where, when, and how PMSS were done. Nearly all respondents (99.6%) indicated they performed PMSS at least some of the time; however, almost a third did not use PMSS for all suspected Sudden Infant Death Syndrome (SIDS), abuse, unsafe sleep, or undetermined causes of death. Despite evidence that "babygrams" are inappropriate in a SIDS workup, 30% of pathologists use them preferentially. Despite SIDS being a diagnosis of exclusion that requires a PMSS, almost 10% of pathologists do not order a PMSS. Future research is necessary to reduce barriers to this important component of the pediatric forensic autopsy.
authors.affiliation: Department of Pediatrics, Riley Hospital for Children, Children's Health Services Research, Indiana University School of Medicine, 410 West 10th Street, Suite 1020, Indianapolis, IN 46202, USA. alaskey@iupui.edu
authors.forename: Antoinette L
authors.initials: AL
authors.lastname: Laskey
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Haberkorn
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Applegate
authors.forename: Michele J
authors.initials: MJ
authors.lastname: Catellier
mesh_terms: D000488:Allied Health Personnel; D001237:Asphyxia / Q000175:diagnosis; D001344:Autopsy / Q000379:methods*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002649:Child Abuse / Q000175:diagnosis; D002675:Child, Preschool; D003334:Coroners and Medical Examiners; D049429:Forensic Pathology; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D013398:Sudden Infant Death / Q000175:diagnosis; D011795:Surveys and Questionnaires; D014481:United States