Emergency Department Visits Before Sudden Unexpected Infant Death: A Touchpoint for Unsafe Sleep Reduction |
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| Affiliation: | 1. Division of Emergency Medicine (B Kappy, K Edmunds, M Frey, Y Zhang, S Boyd, WJ Pomerantz, and B Kerrey), Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;2. Department of Pediatrics (K Edmunds, WJ Pomerantz, B Kerrey and S Hanke), University of Cincinnati College of Medicine, Cincinnati, Ohio;3. Hamilton County Coroner''s Office (K Looman), Cincinnati, Ohio;4. Department of Pathology and Laboratory Medicine (K Looman), University of Cincinnati, College of Medicine, Cincinnati, Ohio;5. Heart Institute, Cincinnati Children''s Hospital Medical Center (S Hanke), Cincinnati, Ohio;1. Department of Pediatrics, University of Washington School of Medicine and Seattle Children''s Hospital (EK Chung), Seattle, Wash;2. Department of Pediatrics, Johns Hopkins University School of Medicine (BS Solomon and EM Perrin), Baltimore, Md;3. Johns Hopkins University School of Nursing (EM Perrin), Baltimore, Md;4. Department of Pediatrics, Boston Children''s Hospital and Harvard Medical School (A Starmer), Boston, Mass;5. Department of Pediatrics, Baylor College of Medicine and Texas Children''s Hospital (TL Turner), Houston, Tex;6. Departments of Pediatrics and Medical Education, University of Miami Miller School of Medicine (L Chandran), Miami, Fla;1. Department of Student Affairs, Wake Forest School of Medicine (IL Tablazon and FC O''Brian), Winston-Salem, NC;2. Departments of Internal Medicine, Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine (D Palakshappa), Winston-Salem, NC;3. Departments of Pediatrics, Downtown Health Plaza Pediatrics Clinic, Wake Forest School of Medicine (B Ramirez), Winston-Salem, NC;4. Departments of Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine (JA Skelton), Winston-Salem, NC;5. Department of Pediatrics, Wake Forest School of Medicine (LW Albertini and KG Montez), Winston-Salem, NC;1. Department of Pediatrics (AR Schroeder), Stanford University School of Medicine, Stanford, Calif;2. Department of Pediatrics (LG Solan), Golisano Children''s Hospital at the University of Rochester Medical Center, Rochester, NY;3. Department of Pediatrics (D Williams), Vanderbilt University School of Medicine and the Monroe Carell Junior Children''s Hospital at Vanderbilt, Nashville, TN;4. Pediatric Academic Societies, Inc. (B Thomas, C Smith, and G Minshew);5. Department of Pediatrics (DA Rauch), Tufts University Medical School, Boston, Mass;1. Division of Hospital Medicine (AM Jenkins, K Auger), Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;2. Department of Internal Medicine (AM Jenkins), University of Cincinnati Medical Center, Cincinnati, OH;3. Division of General Pediatrics (JG Berry, P Dunbar, B Garrity), Boston Children''s Hospital, Harvard Medical School, Boston, Mass;4. Division of General Academic Pediatrics, Department of Pediatrics (JM Perrin, K Kuhlthau), MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass;5. Children''s Hospital Association (M Hall), Lenexa, KS;6. Family Voices (C Hoover), Albuquerque, NM;7. Building Bright Futures (M Crossman), Williston, VT;8. Department of Pediatrics, University of Cincinnati College of Medicine (K Auger), Cincinnati, OH;9. James M. Anderson Center for Health Systems Excellence (K Auger), Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;1. Department of Pediatrics (K O''Hara, SI Ziniel), University of Colorado School of Medicine, Aurora, Colo;2. Department of Pediatrics (A Tseng), Virginia Commonwealth University School of Medicine, Richmond, Va;3. Department of Hospital Medicine (S Moss), Cleveland Clinic Community Care, Cleveland, Ohio;4. Department of Pediatric Hospital Medicine (S Moss), Pediatrics Institute, Cleveland Clinic, Cleveland, Ohio;5. Division of Hospital Medicine, Department of Pediatrics (L Herbst, B Herbst), Cincinnati Children''s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Geriatrics & Palliative Care Division, Department of Family and Community Medicine (L Herbst), University of Cincinnati College of Medicine, Cincinnati, Ohio;7. Department of Pediatrics (S Marsicek), AdventHealth for Children, Orlando, Fla;8. Department of Pediatrics (K Molas-Torreblanca), Keck School of Medicine of USC, Los Angeles, Calif;9. Division of Hospital Medicine (K Molas-Torreblanca), Children''s Hospital Los Angeles, Los Angeles, Calif;10. Department of Internal Medicine (B Herbst), University of Cincinnati College of Medicine, Cincinnati, Ohio;11. Department of Pediatrics (J Maniscalo), Johns Hopkins University, Johns Hopkins All Children''s Hospital, Office of Medical Education, St. Petersburg, Fla;1. Department of Pediatrics, Division of Pediatric Neurology (E Catenaccio), Children''s Hospital of Philadelphia, Philadelphia, PA;2. Department of Emergency Medicine, Division of Pediatric Emergency Medicine (JM Rochlin), Maimonides Medical Center, Brooklyn, NY;3. Departments of Pediatrics and Emergency Medicine (HK Simon), Emory University School of Medicine and Children''s Healthcare of Atlanta, Atlanta, GA |
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| Abstract: | ObjectivesUnsafe sleep remains a leading cause of preventable sudden unexpected infant death (SUID). Infants frequently visit emergency departments (EDs), but the frequency of visits before SUID is unknown. The objective of this study was to determine how often SUID infants visited a pediatric ED or urgent care (UC) before death.MethodsWe performed a retrospective study of infant deaths in the county of a large, academic pediatric institution. We linked institutional records with coroner reports and death scene investigations. We excluded deaths associated with childbirth, prematurity, injury, or underlying medical condition. We characterized all SUID infants, focusing on unsafe sleep factors detailed in the medical record and scene reports. The main outcome was ED/UC visit(s) before the visit for SUID.ResultsSeventy-three of 122 infant deaths met inclusion criteria for SUID over 76 months (April 2014–July 2020). Median age at death was 87 days (IQR 58, 137); 68 (93%) died before 6 months-of-age. Twenty infants (27%) had an ED/UC visit before SUID; mean visits for these infants were 1.7 (SD 0.8). Median days between the last ED/UC visit and SUID was 39; five infants visited the ED/UC within 2 weeks of SUID. Most visits were for minor medical conditions. All 73 SUID infants had at least one unsafe sleep factor; 88% had ≥2 and 56% ≥3.ConclusionsMany SUID infants visited a pediatric ED/UC before death, and unsafe sleep factors were found in every case. Early infancy ED/UC visits may present an opportunity for targeted prevention efforts. |
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