Emergency department visits before sudden unexpected infant death: a touchpoint for unsafe sleep reduction
Kappy B, Edmunds K, Frey M, et al. Acad Pediatr. Published online March 18, 2022. doi:10.1016/j.acap.2022.03.009
Sudden unexpected infant death (SUID, pronounced “SOO-id”) is the leading cause of infant death after the first month of life, accounting for more than 3,400 deaths annually in the U.S.
SUID includes all unexpected deaths, eg, those with a cause, such as suffocation, and those without an identified cause, which are called sudden infant death syndrome (SIDS).
Although unsafe sleeping conditions are the leading preventable cause of SUID, and many evolving and expanding initiatives aim to educate the public on safe sleeping techniques, the rate of SUID has not changed over the past 20 years. To date, none of these initiatives have involved the ED.
The authors note that because infants have high rates of ED use, the ED might be able to play a role in prevention, but to justify this effort, infants with SUID must be demonstrated to in fact visit an ED or urgent-care clinic before death.
This is a retrospective cohort study of infants <12 months of age from a single county in Ohio, whose cause of death was SUID, as identified largely via coroner’s records from 2014 to 2020. The authors linked these records to the patients’ individual medical records, and also gathered data from autopsy reports and police investigations.
After excluding patients who died from a known cause, such as illness, 73 cases of SUID remained.
The median age at death was 87 days, 93% died before 6 months of age, and 27% had an ED or urgent-care visit before death. The median number of days between visit and death was 39, and most visits were for minor medical issues.
To classify safety, the authors assessed 4 data elements (sleep-surface sharing, sleep surface, sleeping position, and surrounding soft bedding items) and found that 100% of infants with SUID had at least 1 unsafe sleeping factor, 88% had ≥2, and 56% had >3.
Some limitations of the study include its single-center nature; missing data elements for some cases, largely because of variability in scene records; and the lack of a clear description of the review methods. In addition, the number of babies without SUID who had unsafe sleeping conditions was unknown.
The authors’ own data indicate that SUID is an incredibly rare event but it is likely to be preventable, and that the effectiveness of existing outreach and educational strategies appears to have been maximized. Maybe it is time to look for alternative routes for education.
EDITOR’S COMMENTARY: In this retrospective cohort study, the authors show that, although SUID is a very rare event, one-quarter of kids with SUID were seen in an ED before the event, and all cases identified had at least 1 unsafe sleep condition. The authors suggest that the ED may be a venue for future interventions. If nothing else, we should be aware of sleep factors associated with SUID, and should consider educating patients about them or screening for them in the right clinical environment.
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