Diagnostic drift in sudden infant death syndrome
Kolikof, Joshua S.
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INTRODUCTION: In the years that followed the 1994 Back to Sleep Campaign (BSC), a public health initiative designed to prevent Sudden Infant Death Syndrome (SIDS), the prevalence of SIDS decreased by nearly 50%. However, recent research questions the decline in SIDS with an appreciation of contemporaneous factors which may have contributed to it. There is a growing recognition that other, often indiscernible causes of Sudden Unexpected Infant Deaths (SUID) have increased prevalence rates. Several researchers have addressed the possibility of the effects of a diagnostic drift. OBJECTIVE: To evaluate the impact of certain contemporaneous factors on the decline in the prevalence of Sudden Infant Death Syndrome. METHODS: We examined a historically significant time period surrounding the implementation of the BSC, 1984-2009. It is a time-period that incorporates mortality statistics prior to the BSC, as well as immediately following. We utilized 1984-2009 mortality data obtained from the Center for Disease Control and Prevention and evaluated the following prevalence rates: SIDS, unknown and unspecified causes, Accidental Strangulation and Suffocation in Bed (ASSB), and Neglect. We then amalgamated unknown and unspecified causes, ASSB and Neglect into a single representation of non-SIDS SUID. We then proceeded to perform an analysis on these prevalence rates to determine linear trends. RESULTS: All-cause mortality rate decreased linearly by about .929 per 100,000 per year (p<.0001, β=-.929). SIDS mortality rates also experienced a significant decline of about .951 per 100,000 deaths per year (p<.0001, β=-.951). In contrast, the SUID cohort prevalence increased significantly with a rate of .930 per 100,000 per year (p<.0001, β=.930). DISCUSSION: Over our study period, SIDS declined significantly, but by 2001 it experienced a stagnant decline that was different than that from 1984-2000. From 2001 to 2009, our SUID cohort increased dramatically. It is our conclusion that the potential exists for a possible diagnostic drift from SIDS to these other SUID.
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