title: Classification system for the Sudden Unexpected Infant Death Case Registry and its application.
abstract: Sudden unexpected infant deaths (SUID) accounted for 1 in 3 postneonatal deaths in 2010. Sudden infant death syndrome and accidental sleep-related suffocation are among the most frequently reported types of SUID. The causes of these SUID usually are not obvious before a medico-legal investigation and may remain unexplained even after investigation. Lack of consistent investigation practices and an autopsy marker make it difficult to distinguish sudden infant death syndrome from other SUID. Standardized categories might assist in differentiating SUID subtypes and allow for more accurate monitoring of the magnitude of SUID, as well as an enhanced ability to characterize the highest risk groups. To capture information about the extent to which cases are thoroughly investigated and how factors like unsafe sleep may contribute to deaths, CDC created a multistate SUID Case Registry in 2009. As part of the registry, the Centers for Disease Control and Prevention developed a classification system that recognizes the uncertainty about how suffocation or asphyxiation may contribute to death and that accounts for unknown and incomplete information about the death scene and autopsy. This report describes the classification system, including its definitions and decision-making algorithm, and applies the system to 436 US SUID cases that occurred in 2011 and were reported to the registry. These categories, although not replacing official cause-of-death determinations, allow local and state programs to track SUID subtypes, creating a valuable tool to identify gaps in investigation and inform SUID reduction strategies.
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; ayn9@cdc.gov.
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Shapiro-Mendoza
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Lena
authors.initials: L
authors.lastname: Camperlengo
authors.affiliation: Oak Ridge Institute for Science and Education (ORISE) Research Participant Program, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ludvigsen
authors.affiliation: DB Consulting Group, Inc., Atlanta, Georgia;
authors.forename: Carri
authors.initials: C
authors.lastname: Cottengim
authors.affiliation: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland;
authors.forename: Robert N
authors.initials: RN
authors.lastname: Anderson
authors.affiliation: Office of Chief Medical Examiner, State of New Hampshire, New Hampshire;
authors.forename: Thomas
authors.initials: T
authors.lastname: Andrew
authors.affiliation: National Center for Child Death Review, Michigan Public Health Institute, Okemos, Michigan;
authors.forename: Theresa
authors.initials: T
authors.lastname: Covington
authors.affiliation: Departments of Family Medicine and Public Health Sciences, University of Virginia, Charlottesville, Virginia; and.
authors.forename: Fern R
authors.initials: FR
authors.lastname: Hauck
authors.affiliation: Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Washington University, St Louis, Missouri.
authors.forename: James
authors.initials: J
authors.lastname: Kemp
authors.affiliation: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland;
authors.forename: Marian
authors.initials: M
authors.lastname: MacDorman
mesh_terms: D000465:Algorithms; D002423:Cause of Death; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012042:Registries; D013398:Sudden Infant Death / Q000145:classification*; D014481:United States
keywords: accidental suffocation; child death review; classification; infant mortality; sudden infant death syndrome; sudden unexpected infant death; surveillance