Book Review

Sudden Death in Infancy, Childhood and Adolescence

N Engl J Med 1995; 333:1160-1161October 26, 1995

Article

Sudden Death in Infancy, Childhood and Adolescence
By Roger W. Byard and Stephen D. Cohle. 545 pp., illustrated. New York, Cambridge University Press, 1994. $100. ISBN: 0-521-42031-8

This book begins with a discussion of sudden death and an overview that defines what is meant by “sudden.” There is some variability of definition in the literature, but for this review the victims have either been well or have had an apparently minor illness. If they did have a major illness, their condition was thought to be stable and thus sudden death was unexpected. The style of the entire book is scholarly and thorough. Although sudden death may be considered rare, its incidence in persons 1 to 20 years of age ranges from 1.1 to 13.8 per 100,000 per year, and it accounts for 2 to 5 percent of deaths in that age group. A study from Melbourne, Australia, reported an overall annual mortality rate due to injury and trauma of 10.6 per 100,000 among children from birth to the age of 14. In the United States, a lethal-injury rate of 30.3 per 100,000 annually has been cited for persons from birth to the age of 19. The incidence of sudden death is higher in boys than in girls. Perinatal death is not included in this book.

One of the lengthier chapters is on accidental death, which accounts for nearly half the deaths among persons 1 to 24 years of age in the United States. Accidents cause 3 percent of deaths among infants under 1 year of age but 71 percent of deaths among persons at the age of 15 to 19 years. Nonaccidental deaths can be due to either homicide or child abuse. The book brings the reader to the Munchausen syndrome by proxy, a disorder in which an adult either simulates or causes an illness in a child. The discussions of accidental and nonaccidental deaths read like a review of forensic pathology, but as the book progresses there is logic to the sequence.

Each chapter reads like a conference in which the pathologist holds the clues and answers questions from the clinician and other investigators from the autopsy table. Some pediatricians may take the view that sudden death is so rare as not to be of serious concern, but the review of organ systems reminds clinicians of disorders that may test their diagnostic acumen during the life of the patient. The thoroughness of the review and cross-referencing make this book interesting for study and as a reference for the review of clinical cases in which there may be a risk of sudden death, or for the pathologist and coroner to use on a daily basis.

The final chapter, on sudden infant death syndrome (SIDS), the leading cause of death among infants from one month to one year of age, is an excellent summary of the topic. An important aspect of the book is its appendixes, which include autopsy protocols, particularly for specific conditions, such as sepsis and possible poisoning. The authors include a protocol for autopsy after death from SIDS, which has also been a major focus for other SIDS investigators, particularly in California, where a unified autopsy protocol has been adopted. The authors have chosen not to include a protocol for the investigation of the scene of death, which some have considered to be an important part of the SIDS diagnosis.

This is an outstanding book for practitioners, pathologists, and researchers who wish to learn from the tremendous expertise of Dr. Byard (a senior pathologist at the Children's Hospital in Adelaide, Australia) and Dr. Cohle (a forensic pathologist at the Blodgett Memorial Medical Center in Michigan). In this era of emphasis on cellular and subcellular investigations, we are still left with the responsibility to practice clinical medicine and to use our experience and the literature to recognize conditions both common and rare. This book reminds us of that challenge.

Ronald L. Ariagno, M.D.
Stanford University School of Medicine, Stanford, CA 94305