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Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic conditions: a data linkage study
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  • Published on:
    Response to: Over-estimation of association between SUDIC and chronic conditions

    We thank Dr. Garstang and Dr. Debelle for their comments on our article in ADC (1).

    We are pleased that the correspondents support our finding of a strong association between chronic conditions and respiratory tract Infection mortality in children which, though well-recognised by clinicians, has not previously been quantified.

    The correspondents rightly highlight that our analyses concentrate only on unexpected deaths after age 2 months. We chose this definition because these early deaths are more prone to linkage error and more importantly, tend to be related to maternal health during pregnancy and delivery, preterm birth, intrapartum events and congenital anomalies, and therefore may not be avoidable through improved care after postnatal discharge.

    As our paper highlights, an indication of whether a death was expected or not on a death certificate or in hospital records is necessary in order to assess whether a death was avoidable or amenable to healthcare intervention. A classification of whether a death was expected or unexpected could also be notified to Child Death Overview Panels and other agencies by those completing the death certificates. This would be helpful to Child Death Overview Panels in their deliberations as well as feeding into the collation of mortality statistics‎.


    1.     1. Verfürden ML, Gilbert R, Sebire N, Hardelid P. Arch Dis Child 2018;103:1125–1131.

    Conflict of Interest:
    None declared.
  • Published on:
    Over-estimation of association between SUDIC and chronic conditions
    • Joanna J Garstang, Designated Doctor for Unexpected Child Death Birmingham and Solihull NHS Commissioning Group
    • Other Contributors:
      • Geoff Debelle, Designated Doctor for Child Safeguarding

    We welcome the paper by Verfurden et al1 on avoidable mortality from RTI and SUDIC with chronic conditions. We do not doubt the conclusion that chronic conditions are strongly associated with deaths from RTI, but disagree with the conclusion that chronic conditions are also associated with SUDIC or the need for changes to death certification.
    The study excludes deaths of infants less than 2 months old; however the peak age for unexplained infant deaths (classified as SIDS or unascertained) is 6 weeks. Data from England for the years 2004-10 show that 45% of unexpected infant deaths occurred prior to 2 months of age2, with the exception of those infants with congenital anomalies it is unlikely that these infants will have been diagnosed with a chronic condition by the time of death. Due to these issues, the study is likely to have significantly over-estimated the association of chronic conditions with SUDIC and we would invite the authors to revise their conclusion.
    The authors suggest that death registrations and hospital databases should categorise deaths as expected or unexpected to help identify potentially preventable deaths. Child Death Overview Panels in England review all deaths, determining modifiable factors; and these reviews are to be collated nationally by the new established National Child Mortality Database. A similar system of Child Death Reviews has already been recommended by the Scottish Government. It would seem more sensible to fully embrace...

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    Conflict of Interest:
    None declared.