Local recommendations for death scene investigation of sudden unexpected death in infants (SUDI) based on prospective observations.

Abstract

The analyses of death scenes of sudden unexpected death in infants (SUDI) form an integral part of postmortem investigations. However, previous research has suggested that death scene investigation in SUDI cases is inconsistent and limited in South Africa. To suggest realistic and feasible improvements for SUDI scene investigation by means of prospective observation. Ten SUDI cases were followed up from death scene until autopsy and detailed observations were made using a semi-structured checklist. Data were analysed in conjunction with published data from the same mortuary to suggest realistic improvements. In all observed cases, the infant was moved prior to the arrival of forensic pathology officers; yet, reconstruction of the events leading to death were never demonstrated with a doll. The use of photography varied, with a median of 15 (standard deviation 6.5) photographs taken at each scene. However, critical photographs, such as those of medication, were often omitted. Furthermore, medicine was not collected from any scene. The use of documentation was inconsistent, where the intended longitudinal use was achieved in only 2 of 10 cases. Forms were inadequately filled in, due to the sensitivity or lack of understanding of various questions, rendering the forms incomplete. Training of specialised staff should therefore focus on five areas: doll re-enactment, photography, handling of medicine, accurate use of relevant documentation and use of a glossary. The implementation of these recommendations is deemed to be feasible in a resource-scarce mortuary setting and could assist other mortuaries in the development of locally relevant strategies.