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Pathologists’ terminology for sudden infant deaths

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Whatever terms are used for sudden unexpected deaths in infancy (SUDI) it is important that terminology should be agreed and standardised; everybody should “sing from the same hymn sheet”. A survey carried out for the Foundation for the study of Infant Deaths, in collaboration with the Office of National Statistics and the Royal College of Pathologists (

) has shown that pathologists vary in their use of terms when reporting on SUDI.

A questionnaire was sent to all 105 pathologists known by the Royal College of Pathologists to perform SUDI autopsies. There were 63 satisfactory replies (five responders said they no longer did SUDI autopsies and there were 37 nonresponders). Of the 63, 29 were forensic pathologists, 24 paediatric pathologists, and 10 general pathologists (six with forensic accreditation). They were asked if they used the term “unascertained” when they found no adequate cause for death. Eleven always used the term, 19 used it frequently, 26 occasionally, and seven never. Of the 56 pathologists who used the term 38 would use it whenever death had occurred while the infant was sharing a bed with an adult and 37 when there were suspicious features in the history or at autopsy. Eight pathologists admitted using the term to obtain an inquest.

Sixty-two respondents answered a question about information available to them at the time of the autopsy and half (32) of these complained that the information was usually inadequate; they wanted more information about the medical and social history and the antecedents and circumstances of death. Fifty-two routinely received a report from the coroner’s officer but only ten regularly had a report from a health professional. Thirty-two said they sometimes visited the scene of the death. Thirty-eight pathologists believed that the term SIDS was still useful, 24 did not, and one was undecided. For sudden unexplained death while sharing a bed with an adult 38 would use the term unascertained, 25 would call it SIDS, six SUDI, and one asphyxia (some would use different terms in different circumstances). Eighteen of the 63 pathologists performed fewer than six SUDI autopsies a year.

There is variation in the use of the term “unascertained” but whereas SIDS implies a natural cause, unascertained does not exclude unnatural death. The authors of this paper point out that use of the term “unascertained” could therefore stigmatise the family. They call for all SUDI to be given the same designation initially and for more specific, or potentially accusatory, terms to be used only after full investigation, often including an inquest.