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Bundock EA, Corey TS, Andrew TA, et al., editors. Unexplained Pediatric Deaths: Investigation, Certification, and Family Needs [Internet]. San Diego (CA): Academic Forensic Pathology International; 2019.
| 1 | Cause of Death Entered on Death Certificate: Unexplained Sudden Death (No Identified Intrinsic or Extrinsic Factors) | ||
|---|---|---|---|
| Criteria for certifiers to consider in infant deaths | |||
| 1 | Infant less than one year of age in apparent good health that dies suddenly and unexpectedly. | ||
| 2 | For sleep-related deaths | ||
| a | Placed alone, supine, in infant-specific sleep environment (e.g., crib, bassinet, portable crib, play pen) with flat, firm sleep surface, uncluttered by objects, and without potential areas of entrapment. | ||
| b | Found unresponsive or dead, in the same sleep environment, with no obstruction of the nose and/or mouth or compression of neck/chest to cause asphyxia given the developmental abilities of the infant, as described by finder and demonstrated by doll reenactment (unless doll reenactment declined by caregiver). | ||
| 3 | The infant was not overly dressed or bundled for the environmental temperature. | ||
| 4 | Competent caregiver not impaired by drugs or alcohol. | ||
| 5 | Physical findings on body and at scene consistent with history provided by caregiver. | ||
| 6 | Completion of scene investigation and doll reenactment unless caregiver declines. | ||
| 7 | Review of child medical records and family health history. | ||
| 8 | Complete autopsy with histology, comprehensive toxicology testing (including vitreous chemistries if possible), and skeletal survey. | ||
| 9 | No anatomic, metabolic, toxicologic, chemical, historical, or external cause of death identified. Genetic testing is recommended but not required for this certification. | ||
| 10 | No extrinsic or intrinsic risk factors are identified. | ||
| An infant death certified as “Unexplained Sudden Death (No Identified Intrinsic or Extrinsic Factors)” will be coded as R95 in ICD-10, and MH11 in ICD-11 as proposed. | |||
| To better represent the current and future data captured by R95/MH11, it is recommended that the title of this code be changed to Unexplained Sudden Death in Infancy or Sudden Infant Death Syndrome. | |||
| Development of an extension code by the World Health Organization to capture “No intrinsic or extrinsic factors” is recommended. | |||
| Criteria for certifiers to consider in deaths of children greater than 12 months of age | |||
| 1 | Child greater than 12 months of age in apparent good health that dies suddenly and unexpectedly. | ||
| 2 | For sleep-related deaths | ||
| a | Found unresponsive or dead, with no obstruction of the nose and/or mouth or compression of neck/chest considered sufficient to cause asphyxia given the developmental abilities of the child (prone position without obstruction of nose and/or mouth may be present). | ||
| 3 | Physical findings on body and at scene consistent with history provided by caregiver. | ||
| 4 | Competent caregiver not impaired by drugs or alcohol. | ||
| 5 | Completion of scene investigation and doll reenactment if age or circumstance appropriate and caregiver cooperative. | ||
| 6 | Review of child medical records and family health history. | ||
| 7 | Complete autopsy with histology, comprehensive toxicology testing of blood (including vitreous chemistries if possible). | ||
| 8 | No anatomic, metabolic, toxicologic, chemical, historical, or external cause of death identified. Genetic testing is recommended but not required for this certification. | ||
| 9 | No extrinsic or intrinsic risk factors are identified. | ||
| For a child (365 days of age, a death certified as “Unexplained Sudden Death (No Identified Intrinsic or Extrinsic Factors)” will be coded as R96 in ICD-10, and MH12 in ICD-11 as proposed. | |||
| To better represent the current and future data captured by R96/MH12, it is recommended that the title of this code be changed to Unexplained Sudden Death in Children and Adults | |||
| As noted above, development of an extension code by the World Health Organization to capture “No intrinsic or extrinsic factors” is recommended. | |||
| 2 | Cause of Death Entered on Death Certificate: Unexplained Sudden Death (Intrinsic Factor(s) Identified): | ||
| A cause of death cannot be determined and criteria for Unexplained Sudden Death (No Identified Intrinsic or Extrinsic Factors) are not met due to intrinsic natural abnormalities that are either known intrinsic risk factors for sudden death (including, but not limited to, low birth weight, preterm birth, small for gestational age, concurrent non-lethal illness, febrile seizures) or of unknown significance (including, but not limited, to mutations of unknown significance). Trauma and other unnatural etiologies are sufficiently excluded. | |||
| An infant death certified as “unexplained sudden death (intrinsic factor(s) identified)” will be coded as R95 in ICD-10, and MH11 in ICD-11 as proposed. If the deceased is a child (365 days of age, the death will be coded as R96 in ICD-10 and MH12 in ICD-11 as proposed. | |||
| Development of an extension code by the World Health Organization to capture “Intrinsic factor(s)” is recommended. | |||
| 3 | Cause of Death Entered on Death Certificate: Unexplained Sudden Death (Extrinsic Factors Identified) | ||
| A cause of death cannot be determined and criteria above for “unexplained sudden death (no identified intrinsic or extrinsic factors)” are not met due to the presence of unintentional extrinsic factors that increase risk for unnatural death. For infants this includes, but is not limited to, side or prone sleep if unable to roll to supine, overheating, objects in sleep environment, infant in sleep environment not specifically designed for infant sleep, soft or excessive bedding, and sleep-surface sharing. At all pediatric ages this may include, but is not limited to, nonlethal injuries or injuries of unknown significance, nonlethal toxicologic findings of unknown significance, or circumstances otherwise concerning for unnatural death. | |||
| An infant death certified as “unexplained sudden death (extrinsic factors identified)” will be coded as R95 in ICD-10, and MH11 in ICD-11 as proposed. If the deceased is a child (365 days of age, the death will be coded as R96 in ICD-10 and MH12 in ICD-11 as proposed. | |||
| Development of an extension code by the World Health Organization to capture “Extrinsic factor(s)” is recommended. | |||
| 4 | Cause of Death Entered on Death Certificate: Unexplained Sudden Death (Intrinsic and Extrinsic Factors Identified) | ||
| A cause of death cannot be determined and a combination of intrinsic and extrinsic factors are present. | |||
| For an infant, a death certified as “unexplained sudden death (intrinsic and extrinsic factors identified) will be coded as R95 in ICD-10, and MH11 in ICD-11 as proposed. If the deceased is a child (365 days of age, the death will be coded as R96 in ICD-10 and MH12 in ICD-11 as proposed. | |||
| As noted above, development of extension codes by the World Health Organization to capture “Extrinsic factor(s)” and “Intrinsic factor(s)” is recommended. | |||
| 5 | Cause of Death Entered on Death Certificate: Undetermined (Not further specified) | ||
| A cause of death cannot be determined due to circumstances or findings that make the above classifications inapplicable. Examples may include cases with inconsistent histories and/or other evidence that raise uncertainty about manner of death, or those which remain undetermined but were not sudden, and those with competing causes. | |||
| Deaths certified as “undetermined (not further specified)” will be coded as R99 in ICD-10, and MH14 in ICD-11 as proposed, whether the deceased is an infant or child. | |||
| Development of an extension code by the World Health Organization to capture “Not further specified” is recommended. | |||
| 6 | Cause of Death Entered on Death Certificate: Undetermined (Insufficient Data) | ||
| A cause of death cannot be determined because investigation, death scene examination, or autopsy were substantially limited, incomplete, or insufficient. Examples may include cases with legal/religious restrictions, delayed report of death that limits scene investigation, and decomposition. | |||
| Deaths certified as “undetermined (insufficient data)” will be coded as R99 in ICD-10, and MH14 in ICD-11 as proposed, whether the deceased is an infant or child. | |||
| Development of an extension code by the World Health Organization to capture “Insufficient data” is recommended. | |||
From: Chapter 10, Death Certification and Surveillance
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