By  Children’s Health Defense Team

Widespread inconsistencies in death certification mean that the U.S. public health agency is almost certainly underestimating how often such deaths occur, report authors say.

When a child 12 months of age or older dies unexpectedly and no one can figure out why, the death goes into a catch-all mystery basket called “sudden unexplained death in childhood” (SUDC). The Centers for Disease Control and Prevention (CDC) says that close to 400 children died suddenly and without a clear cause of death in 2017 and 2018, respectively, but a new study in the Journal of the American Medical Association (JAMA) questions the CDC’s figures. According to the university researchers and medical and forensic experts authoring the study, widespread inconsistencies in death certification mean that the U.S. public health agency is almost certainly underestimating how often such deaths occur.

Boys represent the majority of SUDC cases, and the risk is more than two-fold greater for African American children than for other groups. And though the CDC tracks the unexpected fatalities through age 18, the average age of death is two years (32 months in the JAMA study). Nearly all affected children are born full-term, having been developing normally and “in their state of usual good health prior to death” — which happens mostly during sleep. Without much of anything to go on, the unpredictable deaths, according to the JAMA study’s lead author, “elude … scientific understanding.”

Dysfunctional death records

According to professionals who work with death records, the “process for creating and registering causes of death for public records is a complicated, convoluted, and politicized one” that results in a “mostly uninvestigated and inaccurate picture of what causes a death.” The JAMA study’s review of 100 autopsied cases referred to the SUDC Registry and Research Collaborative for additional investigation (92% from the U.S. and 8% from Canada or the UK) bears out this observation. After combing through medical records, death scene investigations, autopsy findings, ancillary tests and available genetic data, the authors show that for four out of ten SUDC cases reviewed, their cause-of-death determination did not match the original verdict, with even more disagreement (61% of cases) about how to interpret lab findings. Not only did many of the death certificates put forth causes “that weren’t supportable on further inspection,” but notably, the reviewers considered 28 deaths to be “unexplained” that the original certifiers had termed “accidental” or “natural.”

The JAMA authors and other experts highlight a number of failings of the death certification process as it pertains to SUDC. They cite:

• A “dire shortage” of practicing and available medical examiners in the U.S.: After the National Research Council flagged the shortage in 2009, the opioid epidemic created a “glut of cases” that has exacerbated the problems. In February of this year, the New York Times reported that chief medical examiners in large metropolitan areas “have resigned in protest over intolerable case loads and insufficient funding and resources.” A recent multistate analysis by CDC researchers of “sudden death in the young” (SDY) found that medical examiners declining cases was a common reason for the absence of autopsy results.
• Inadequate attention to organ histology: Although the brain and heart are frequently implicated in sudden death, the JAMA authors found that examinations of the two organs frequently were “substandard” —  at least 28% of the time for the brain and 21% of the time for the heart. Tissue findings for the brain and heart represented key areas of disagreement between the original pathologists and the reviewers. In the CDC’s recent review of SDY cases, “possible cardiac” deaths were a frequent reason for classifying a sudden childhood death as “unexplained.”
• Pressure to come up with an explanation: The JAMA authors suggest that investigators may prefer to pin sudden child deaths on accidental or natural causes or minor pathologies such as bronchitis — rather than pronouncing a death “unexplained” — out of a desire “to avoid the limbo of an unexplained certification” and the appearance of an “incomplete investigation” or one in which “information was overlooked.” Quoting one medical examiner as stating “I had to put something down,” they observe that “real or perceived pressure to identify a [cause of death] may lead some to unwarranted determinations.”

Vaccination — “overlooked” information

Childhood mortality researchers have noted that even when autopsy and ancillary data are available, a significant number of sudden unexpected childhood deaths tend to remain unexplained. In late 2019, Japanese forensic pathologists writing in the American Journal of Forensic Medicine and Pathology highlighted one potential cause of sudden death that American researchers typically ignore or dismiss: vaccination […]

Via https://childrenshealthdefense.org/defender/sudden-unexplained-deaths-children-undercounted-jama-study/