The SIDS rate has been declining significantly since the early 1990s. However, CDC research has found that the decline in SIDS since 1999 can be explained by increasing SUID rates (e.g., deaths attributed to overlaying, suffocation, and wedging). This change in reporting or classification of SUID can be explained by changes in how investigations are conducted and how diagnoses of SUID are made. For example, more deaths are attributed to accidental suffocation that to SIDS.

Inaccurate Reporting

Many SUID cases are not investigated, and when they are, cause-of-death data are not collected and reported consistently. Inaccurate classification of cause and manner of death hampers prevention efforts and researchers are unable to adequately monitor national trends, identify risk factors, or evaluate intervention programs. We need valid and reliable data to support research and prevention efforts if we want to reduce these infant deaths.

SUIDI

In 2003, CDC began leading the effort to revise the 1996 SUID Reporting Form and Guidelines for the scene investigation, as well as actively educating and disseminating training materials on infant death scene investigations to improve inaccurate classification of SUID in the United States. In 2004, CDC's Division of Reproductive Health (DRH) and its partners implemented additional activities aimed at improving the accuracy and consistency of the reporting and classification of SUID deaths. These activities included the development of a new standard investigation reporting form, training curriculum materials for conducting a thorough SUID death scene investigation, a planned effort to disseminate and promote the use of these SUID investigations tools and materials, and the development of a SUID case registry.

SUIDI Goals

The goals of the SUIDI are to develop tools and protocols to

• Standardize and improve data collected at infant death scenes.
• Promote consistent diagnosis and reporting of cause and manner of death for SUID cases.
• Prevent SUIDs by using improved data to monitor trends and identify those at risk.

SUIDI Reporting Form

In March 2006, a revised reporting form known as the Sudden, Unexplained Infant Death Initiative Reporting Form (SUIDI Reporting Form) was released. This form is because it

• Contains 25 questions that medical examiners/coroners should ask before autopsy.
• Guides the investigator through SUID investigation steps.
• Allows the investigator to document information easily and consistently.
• Produces information that helps the death certifier accurately classify SIDS and other SUIDs.
• Yields information that researchers can use to recognize new risk factors for infant death.

SUIDI Training Academies

As a means of disseminating SUIDI training curriculum and materials, CDC began conducting train-the-trainer academies in five U.S. regions in 2006. These regional, multidisciplinary academies provided training for every state, as well as American Indian/Alaska Native teams. The academies produced more than 250 trainers, including of medical examiners, coroners, law enforcement officers, child advocates, college faculty members, and medicolegal death scene investigators. Individuals participating in these academies are expected to conduct additional trainings at conferences, meetings, and courses in their respective states.

Topics covered at the training academy include how to

• Complete the SUIDI Reporting Form.
• Interviewing families.
• Conduct death scene reenactments or recreations (e.g., how was the infant discovered, and what was the sleeping environment.)
• Use Web-based electronic reporting system to allow rapid communication from the death scene investigator to the forensic pathologist.

SUID Case Registry

In 2006, CDC began pilot testing a SUID case registry  to collect information about the circumstances surrounding infant deaths. Information about the sleep environment and the conduct and quality of the death scene investigation is important. Data from this registry will allow CDC and its partners to quantify the extent of reporting problems on death certificates and thus to better monitor trends in SUID cases and identify risk factors.

SUIDI Impact

To date, the SUIDI Reporting Form and training curriculum have been endorsed by several national organizations representing law enforcement, medical examiners, and coroners. Nearly 10,000 individuals have been trained, and many jurisdictions have reported that they are using the new SUIDI Reporting Form.

Page last reviewed: 6/10/08
Page last modified: 6/10/08
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion