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Characteristics That Distinguish Abusive From Nonabusive Causes of Sudden Unexpected Infant Deaths

Bechtel, Kirsten, MD*; Derbyshire, Meagan, BS; Gaither, Julie R., PhD, MPH, RN*; Leventhal, John M., MD*

doi: 10.1097/PEC.0000000000001787
Original Article: PDF Only

Background Fatal child abuse can be mistaken for sudden unexpected infant death (SUID) in the emergency department setting. It is unknown if there are characteristics that distinguish abusive from nonabusive causes of SUIDs in the emergency department.

Methods Using a matched case-control design, we reviewed the medical examiner records of deaths of infants younger than 12 months who were found unresponsive at a residence, required cardiopulmonary resuscitation, and had a complete forensic autopsy between 2009 and 2015. Infants with a manner of death as homicide were cases; controls were those with the manner of death as accident, natural, or undetermined. Each case was matched with 5 controls based on age (months). Differences between cases and controls were evaluated with respect to demographic, parental, and household characteristics and clinical outcomes.

Results We identified 12 cases (homicides) and 169 controls (nonhomicides), of which 60 were selected for the matched analysis. We found no significant differences between cases and controls with respect to age, race, sex, maternal substance use, Child Protective Services involvement prior to death, presence of male head of household, surviving siblings, or emergency medical services transport. Cases were more likely to have Child Protective Services involvement at the time of death (83% vs 38%; P = 0.01), sentinel injuries (odds ratio, 9.67; 95% confidence interval, 1.30–122.43), and return of spontaneous circulation (odds ratio, 29.99; 95% confidence interval, 3.70–241.30).

Conclusions Child Protective Services agency involvement at time of death, sentinel injury, and return of spontaneous circulation were more often associated with abusive causes of SUID. Further study is needed to confirm these findings.

From the *Department of Pediatrics, Yale School of Medicine, New Haven; and

John Netter School of Medicine, Quinnipiac University, Hamden, CT.

Disclosure: The authors declare no conflict of interest.

Reprints: Kirsten Bechtel, MD, Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale School of Medicine, 100 York St, Suite 1F, New Haven, CT 06511 (e-mail:

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