Testing for Infectious Diseases in Sudden Unexpected Infant Death: A Survey of Medical Examiner and Coroner Offices in the United States

• Published in: The Journal of pediatrics Vol. 167; no. 1; pp. 178 - 182.e1
• Main Authors: Brooks, Erin G., Gill, James R., Buchsbaum, Robert, Utley, Suzanne, Sathyavagiswaran, Lakshmanan, Peterson, Diane C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Biopsy - utilization; Blood - microbiology; Blood - virology; Cerebrospinal Fluid - microbiology; Cerebrospinal Fluid - virology; Clinical Laboratory Techniques - utilization; Communicable Diseases - diagnosis; Coroners and Medical Examiners; Humans; Infant; Lung - microbiology; Lung - virology; Pediatrics; Polymerase Chain Reaction - utilization; Practice Patterns, Physicians' - statistics & numerical data; Sudden Infant Death; Surveys and Questionnaires; United States; United States; ME/C; SUID; CDC; CSF; NAME; Centers for Disease Control and Prevention; Medical examiner and coroner; Sudden unexpected infant death; National Association of Medical Examiners; Cerebrospinal fluid
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2015.04.007

To determine interoffice variability in routinely performed sudden unexpected infant death (SUID) postmortem studies for infection and to assess availability and perceived utility of various tests of infectious diseases. Online surveys were sent to all 154 offices of US medical examiners and coroners serving populations >300 000 people. Surveys included a set of potential laboratory tests for infectious disease. Respondents were asked to select which tests were available in their offices, and which tests were performed routinely in SUIDs vs which tests should be performed routinely. Of the 45 complete responses, 4.4% did not routinely perform histology, 8.9% did not routinely perform viral studies (ie, culture or molecular diagnostics), 22.2% did not routinely perform blood cultures, 26.7% did not routinely perform lung bacterial cultures, and 44.4% did not routinely perform cerebrospinal fluid cultures. Our findings suggest that there is considerable interoffice variability with testing for infectious diseases in SUIDs. This appeared to be largely the result of a perceived lack of testing utility rather than a lack of test availability. Evidence-based practice guidelines regarding the interpretation of microbial testing results, as well as common testing protocols/algorithms, may lead to more accurate and standardized data, thus improving SUID investigation and surveillance.