Suffocation Deaths Research Articles

Child Injury Deaths: Comparing Prevention Information from Two Coding Systems

The International Classification of Disease (ICD) external cause of injury E-codes do not sufficiently identify injury circumstances amenable to prevention. The researchers developed an alternative classification system (B-codes) that incorporates behavioral and environmental factors, for use in childhood injury research, and compare the two coding systems in this paper. All fatal injuries among children less than age five that occurred between January 1, 1992, and December 31, 1994, were classified using both B-codes and E-codes. E-codes identified the most common causes of injury death: homicide (24%), fires (21%), motor vehicle incidents (21%), drowning (10%), and suffocation (9%). The B-codes further revealed that homicides (51%) resulted from the child being shaken or struck by another person; many fires deaths (42%) resulted from children playing with matches or lighters; drownings (46%) usually occurred in natural bodies of water; and most suffocation deaths (68%) occurred in unsafe sleeping arrangements. B-codes identify additional information with specific relevance for prevention of childhood injuries.

β-amyloid precursor protein immunohistochemistry in the evaluation of pediatric traumatic optic nerve injury

Objective The pathologic markers of nonaccidental injury (NAI) of the central nervous system (CNS) of infants and young children include subdural, subarachnoid, and retinal hemorrhages. Immunohistochemical staining for β-amyloid precursor protein (βAPP) has been used to investigate traumatic axonal injury of the brain, brain stem, and spinal cord injuries, and has potential as an additional indicator of traumatic head injury. A single study has reported that βAPP immunostaining of the optic nerve in CNS NAI reveals axonal damage. The purpose of our study was to explore further the utility of βAPP immunostaining of optic nerves for the detection of traumatic axonal injury. Methods We used hematoxylin–eosin and βAPP immunostaining to evaluate the eyes and optic nerves in 18 cases of CNS nonaccidental blunt force head injury, 4 cases of homicidal blunt force abdominal injury (BFAI), 1 homicidal suffocation, 1 case of sudden infant death syndrome, 1 near-drowning, 1 overlay (clinical history: “found under sleeping mother in bed”), 1 motor vehicle accident, and 6 natural deaths in children ≤5 years of age. Results Evaluation of the cases of CNS NAI revealed 17 of 18 (94%) with subdural hemorrhage; 15 of 18 (83%), subarachnoid hemorrhage; 17 of 18 (94%), retinal hemorrhage; 16 of 18 (88%), perioptic nerve hemorrhage; and 6 of 18 (33%), optic nerve βAPP immunoreactive axonal swellings. The only nontraumatic case that demonstrated βAPP immunoreactive axonal swellings was the near-drowning. No cases of BFAI, suffocation, overlay, or natural deaths revealed any retinal or perioptic nerve hemorrhage or significant optic nerve βAPP immunoreactivity. Global hypoxic–ischemic injury was present in 21 cases, of which 19 had evidence of brain swelling, and 7 demonstrated βAPP immunoreactive axonal swellings. Conclusions These findings confirm the presence of optic nerve axonal injury in some cases of fatal pediatric CNS NAI.

Child injury mortality in New Zealand 1986-95.

Injury has been described as 'the last major plague of the young'. We provide an epidemiological description of injury, as a leading cause of death in New Zealand, and identify options for prevention. We identified all deaths due to any cause for the period 1986-95 from the national data and calculated the potential years of life lost for each death. For the same period, we identified all injury deaths for children aged 0-14 years. Causes of injury were examined in four age groups. In the population as a whole, injury was the fourth leading cause of death and the leading cause of potential years of life lost. Injury killed children at the rate of 16.8 per 100,000 person-years. The victims were predominantly male (62%) and 52% were under 5 years of age. In infancy (<1 year of age), suffocation was the leading cause of injury mortality. From 1 to 14 years of age, motor vehicle traffic incidents were the leading cause of mortality. Motor vehicle traffic incidents, drowning, suffocation and suicide stood out as areas with the greatest potential for reducing child injury mortality. A number of existing prevention strategies show promise (e.g. child restraints), others are inadequately implemented (e.g. swimming pool fencing) or are of unknown efficacy (e.g. government suicide prevention policies). Strategies to reduce infant suffocation and child non-traffic pedestrian deaths remain to be developed and tested.

Sleep Location and Suffocation: How Good Is the Evidence?

To the Editor. In their article “Infant Mechanical Suffocation Deaths in the United States, 1980–1997,” Drago and Dannenberg analyze a case series of 2178 infant deaths that they classified as “suffocation” based on the Consumer Product Safety Commission's (CPSC) Death Certificate File (DCF), providing a sobering reminder of environmental hazards to infants, such as wedge spaces around mattresses/cushions and strangulation risks from cords or widely spaced crib rails.1 However, the data do not necessarily support their recommendations that “bed sharing and the use of adult beds for infants should be discouraged” or that regulations should “forbid the use of a bed for an infant or toddler.” Such recommendations require knowledge of the relative risk of different sleeping locations (eg, cribs vs playpens vs beds, etc), information which is not discernable from the CSPC-DCF for two reasons. First, the denominator is unknown (the proportion of time infants in the population spent in each location). We will focus on the second and more complicated issue of numerator reliability. Concerns about the reliability of case definition stem first from variability in the gathering, interpretation, and reporting of information to the CPSC.2 ,3 Variation arises from 1) inconsistent data collection procedures, 2) disparate qualifications of those who investigate and certify death, with certifiers ranging from coroners with no medical training to forensic pathologists, and 3) lack of objective criteria to distinguish suffocation from sudden infant death syndrome (SIDS).4 As an example of possible resulting classification bias, O'Hara noted a geographic clustering of the suffocation subcategory “overlaying” on review of the CPSC-DCF data since 1995. Certifiers from areas where the term was used most frequently related by phone interview that they would not diagnose SIDS in the context of co-sleeping, assuming sleep location to be a possible contributory factor. In contrast, some …

Suffocation, shaking or sudden infant death syndrome: can we tell the difference?

Given that the diagnosis of sudden infant death syndrome (SIDS) remains one of exclusion, problems still exist in distinguishing possible cases from those where the deaths were due to accidental or inflicted suffocation. The term 'SIDS' cannot be used unless a complete autopsy examination has been performed, augmented by review of the clinical history and examination of the death scene. In the absence of a cause of death, a more suitable designation in the presence of inflicted injury is 'undetermined' rather than 'SIDS'. Use of standard autopsy and death scene protocols that have been endorsed by professional bodies will improve the investigation of unexpected infant death and will increase the likelihood of diagnosing subtle disorders that may be confused with SIDS.

Infant mechanical suffocation deaths in the United States, 1980-1997.

To document specific patterns and products associated with mechanical suffocation among infants younger than 13 months of age for the period 1980 to 1997. A total 2178 case summaries from the US Consumer Product Safety Commission's Death Certificate File were reviewed. A computerized database was created for information about the infants, products, and patterns of suffocation. The relationships among products, patterns, and age groups were analyzed by chi2. Thirty-eight investigations conducted on a subset of cases involving cribs were reviewed for details on crib age, structural integrity, and compliance with the federal crib regulation. Mortality rates were calculated based on the US population younger than 1 year old. The most frequent causes of suffocation were 1) wedging between a bed or mattress and a wall and 2) oronasal obstruction by plastic bag. Patterns of suffocation were significantly related to age group, but not to sex. Pattern-specific mortality rates comparing three time frames for the the 16-year period from 1980 to 1995 showed continued increases for overlain and oronasal obstruction; an increase followed by a plateau for wedging, a decrease for hanging, and no substantial change for entrapment with suspension. Suffocation hazards presented by beds, bedding, pillows, and plastic bags continue to be underrecognized by parents and caregivers. Bed-sharing and use of adult beds for infants should be discouraged. Only complying cribs should be used and maintained properly to ensure structural integrity. Suffocation deaths involving plastics should be investigated to determine the specific material characteristics and use patterns to design more effective interventions than selective labeling.

The Thymus, Suffocation, and Sudden Infant Death Syndrome—Social Agenda or Hubris?

The Thymus, Suffocation, and Sudden Infant Death Syndrome—Social Agenda or Hubris?

Suffocation, recurrent apnea, and sudden infant death

We reviewed the cases of 27 young children from 27 different families who were suffocated by their mothers. The certainty, or near certainty, of suffocation was based on reliable observation or recording of the suffocation, maternal confession, or successful prosecution in a criminal court. Eighteen of the children are alive, although one has severe brain damage; nine are dead. Twenty-four were reported to have had previous episodes of apnea, cyanosis, or seizure, and 11 had had 10 or more such episodes that were either invented or caused by the mother. Repetitive suffocation usually began between the ages of 1 and 3 months and continued until it was discovered, or the child died, 6 to 12 months later. The 27 children had 15 live elder siblings and 18 who had died suddenly and unexpectedly in early life; 13 of the dead siblings had had recurrent apnea, cyanosis, or seizures, and, although most of them at the time of death were certified as having sudden infant death syndrome, it is probable that some were suffocated. Repetitive suffocation has a characteristic clinical presentation that should allow identification before brain damage or death occurs. The characteristics should also allow the cause of death of some cases of sudden infant death to be established more accurately.

Suffocation and sudden infant death syndrome

Suffocation and sudden infant death syndrome

Suffocation and sudden infant death syndrome

Suffocation and sudden infant death syndrome

Suffocation and sudden infant death syndrome.

Suffocation and sudden infant death syndrome.

Suffocation and sudden infant death syndrome: Author's reply

Suffocation and sudden infant death syndrome: Author's reply

Effectiveness of measures to prevent unintentional deaths of infants and children from suffocation and strangulation

Unintentional deaths from suffocation and strangulation account for about 20 percent of all nontransport-related infant and child fatalities in the United States. In the late 1950s, some preventive countermeasures were introduced to reduce the number of deaths resulting from refrigerator or freezer entrapment. A few years later, countermeasures were introduced to prevent deaths resulting from suffocation by plastic bags, inhumation, and mechanical strangulation from wedging in infant cribs. For three of these major causes of suffocation and strangulation deaths among infants and children (refrigerator or freezer entrapment, suffocation by plastic bag, and inhumation at construction sites), there appears to have been a significant decline in incidence; however, there is no evidence of a significant reduction in deaths from mechanical strangulation in cribs. The impact of current countermeasures is discussed, and some suggestions for new or modified approaches are made.