Accidental mechanical asphyxia of children in Germany between 2000 and 2008

Risk Management and Recommendations for the Prevention of Fatal Foreign Body Aspiration: Four Cases Aged 1.5 to 3 Years and Mini-Review of the Literature

(1) Background: Foreign body aspiration (FBA) is a significant public health concern among the pediatric population, and fatalities are dramatic for families. It typically involves organic foreign bodies (mainly food) aspirated by children under three years old, usually at home or school. This review aimed to focus on the preventive measures around four actual cases of fatal foreign body aspiration, emphasizing the correct execution of the Heimlich maneuver and cardiopulmonary resuscitation, supervised mealtimes, and high-risk foods. (2) Methods: Four fatal cases of foreign body aspiration in children are presented here. The children were in a free environment, such as school, home, and the countryside, and were in the presence of teachers, parents, and a grandmother who did not supervise the children adequately. A literature review was performed via the MEDLINE database using the key terms: “foreign body aspiration,” “infant choking, 1.5 to 3 years,” “food and foreign body aspiration,” “common household,” “prevention of foreign body aspiration,” “guidelines,” “recommendations,” “training of caregivers (parents, educators),” “resuscitation,” “Heimlich maneuver,” and “disengagement of the upper airways.” We focused on the prevention of foreign body aspiration. (3) Results: a complete postmortem examination was performed. In three cases, the foreign bodies were food (mozzarella cheese, pear, or raw bean), while in one case, the foreign body was a pebble. (4) Conclusions: This review aimed to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach to the management of fatal foreign body aspiration in children by caregivers who usually have no experience with the best ways of supervising children in a safe environment, especially regarding the correct execution of resuscitation maneuvers, such as the Heimlich maneuver. Recommendation updates could improve healthcare quality in a pediatric setting and reduce medico-legal implications.

Cases of asphyxia in children and adolescents: a retrospective analysis of fatal accidents, suicides, and homicides from 1998 to 2017 in Hamburg, Germany

PURPOSE

Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents.

METHODS

All cases of asphyxia in children and adolescents (0-21 years of age) among the Hamburg Legal Medical Department's autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent.

RESULTS

Among 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15-21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases.

CONCLUSION

Asphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.

Sudden unexpected infant death characteristics in the French region of West Provence-Alpes-Côte d'Azur

Background: Although the incidence of sudden unexpected infant death (SUID) has decreased since the 'Back to Sleep' campaign in English-speaking countries and other preventive campaigns, the circumstances of such deaths remain unclear. Aim: To analyse infant deaths recorded at the referral centre for sudden infant death of the West Provence-Alpes-Côte d'Azur region of France (West PACA) and the forensic medicine department of Marseille University Hospital. Methods: Information on all SUID cases from 2000 to 2017 was extracted from the referral centre for sudden infant deaths in West PACA and the forensic medicine department of Marseille. Results: The study included 130 infants over the 17 years with a very similar distribution. There was a marked male preponderance, with 61.6% of boys whatever the age at death (sex ratio 1.6). Half of the deaths occurred in the first 6 months of life and the majority (61%) of infants died during autumn and winter. Nearly one-third (33.2%) had presented with minor infections and 21% had been seen by a doctor or had been admitted to hospital. Most deaths (86.4%) occurred during sleep (night or day). Nearly half of the infants (47.7%) were discovered in a prone position. A large majority of parents (90.7%) agreed to a post-mortem examination. Only 6.2% of deaths led to legal proceedings. Nearly 16.9% remained unexplained after compiling all the data included in the protocol and 9.2% remained unexplained because of incomplete investigation, including refusal of post-mortem examination. Abuse was involved in 2.3% of cases. Conclusions: Asymptomatic infectious conditions were associated with a high proportion of SUID cases. Non-supine sleep positions were still practised. There is a need to increase SUID prevention campaigns. Abbreviations: HAS, Haute Autorité de Santé: French National Health Authority; NICHD, National Institute of Child Health and Human Development; PACA, Provence-Alpes-Côte d'Azur region of France; SUID, sudden unexpected infant death; SIDS, sudden infant death syndrome; CépiDc, Centre d'Epidémiologie sur les Causes Médicales de Décès/Center for Epidemiology on the Medical Causes of Death.

Under-five mortality from unintentional suffocation in China, 2006-2016

Background

We used nationally representative data to examine trends in under-five unintentional suffocation mortality from 2006 to 2016 in China and mortality differences across age groups, sexes, rural vs urban locations and injury mechanisms.

Methods

Mortality data came from 161 surveillance points of China's disease surveillance points (DSPs) system. Unintentional suffocation deaths were identified through the 10th International Classification of Disease (ICD-10 codes: w75-w84). Negative binomial regression tested the significance of change in overall and subgroup mortality between 2006 and 2016.

Results

Despite minor fluctuations, a steady trend in overall age-adjusted unintentional suffocation mortality was observed from 2006 to 2016 in Chinese children under 5 years of age. Infants (<1 year), boys and rural children had higher mortality rates than children aged 1-4 years, girls and urban children, respectively. Strangulation and suffocation in bed was the most common cause of mortality for infants, accounting for 66% of deaths. Children aged 1-4 years suffered more often from inhalation suffocation (55% of deaths).

Conclusions

Unintentional suffocation mortality rates in under-five children remained fairly stable in China over the past decade but remained at high levels. We discuss actions that might be implemented to reduce pediatric suffocation rates in China.

Under-five mortality from unintentional suffocation in China, 2006-2016

Background

We used nationally representative data to examine trends in under-five unintentional suffocation mortality from 2006 to 2016 in China and mortality differences across age groups, sexes, rural vs urban locations and injury mechanisms.

Methods

Mortality data came from 161 surveillance points of China’s disease surveillance points (DSPs) system. Unintentional suffocation deaths were identified through the 10th International Classification of Disease (ICD-10 codes: w75-w84). Negative binomial regression tested the significance of change in overall and subgroup mortality between 2006 and 2016.

Results

Despite minor fluctuations, a steady trend in overall age-adjusted unintentional suffocation mortality was observed from 2006 to 2016 in Chinese children under 5 years of age. Infants (<1 year), boys and rural children had higher mortality rates than children aged 1-4 years, girls and urban children, respectively. Strangulation and suffocation in bed was the most common cause of mortality for infants, accounting for 66% of deaths. Children aged 1-4 years suffered more often from inhalation suffocation (55% of deaths).

Conclusions

Unintentional suffocation mortality rates in under-five children remained fairly stable in China over the past decade but remained at high levels. We discuss actions that might be implemented to reduce pediatric suffocation rates in China.

Death as a Consequence of Foreign Body Aspiration in Children

Aim:

To analyze the rate of mortality in children with foreign body aspiration (FBA).

Methods:

We outlined a retrospective review of hospital data of patients between 1971 and 2013. FBA occurring in children 0 year to 14 years was considered for inclusion (patient ages ranged from 0.6 to 15 years, with a median age of 2.2 years). The gender structure within the investigated cases was 75.8% males and 24.2% females. During the study period, 772 patients undergoing rigid bronchoscopy with the diagnosis of FBA were included. Deaths on arrival were excluded.

Results:

Total rate of mortality (for whole investigated period) was 0.785. For last fifteen years of the investigated period the rate of mortality was zero.

Conclusion:

For prevention of foreign body aspiration in children and its mortality should be taken two strategies: non-medical (alterations in product design and public education campaigns) and medical (education of medical staff and improvement of equipment).

Pediatric medicolegal autopsy in France: A forensic histopathological approach

The aim of postmortem medicolegal examination in pediatric death is primarily to establish the circumstances and causes of death and to exclude child abuse. In France, pediatric death is systematically documented by medicolegal or medical autopsy. In case of medicolegal autopsy, the complementary examinations, requested and financed by justice, are rarely limited to a histopathological examination. However in medical autopsies other tools are available to the pathologist as toxicology, biochemistry and molecular biology. The purpose of this article is to evaluate the efficacy of forensic histopathology in pediatric forensic autopsies. We analyze the main causes of pediatric death in a forensic context. Between 2004 and 2015, 157 infant deaths were identified in Marseille university hospital. The forensic histopathology and autopsy reports of all 157 cases were available for systematic review. Medical or surgical causes represented 41,3% of deaths in our center, accidental causes 8.1% and child abuse 28,8%. The definitive diagnosis was made at autopsy in 30% of cases and at histopathological examination in 70% highlighting that forensic histopathology is an indispensable tool in pediatric medicolegal autopsies. Significant histological abnormalities may be detected in selected organs such as the brain, lungs, heart, liver, adrenal glands and kidneys in spite of macroscopically normal appearances. This justifies systematic sampling of all organs. Despite the implementation of the French sudden infant death protocol which recommends medical autopsies, too many pediatric autopsies are carried out in a medicolegal context. 30% of the cases remain without diagnosis at the end of the autopsy and histological examination. This number could be reduced by the contribution of others laboratory investigation.

Disparities in Paediatric Injury Mortality between Aboriginal and Non-Aboriginal Populations in British Columbia, 2001-2009

Injury is the leading cause of death among children and youth in Canada. Significant disparities in injury mortality rates have been observed between Aboriginal and non-Aboriginal populations, but little is known about the age-, sex-, and mechanism-specific patterns of injury causing death. This study examines paediatric mortality in British Columbia from 2001 to 2009 using comprehensive vital statistics registry data. We highlight important disparities in Aboriginal and non-Aboriginal mortality rates, and use the Preventable Years of Life Lost (PrYLL) metric to identify differences between age groups and the mechanisms of injury causing death. A significantly greater age-adjusted mortality rate was observed among Aboriginal children (OR = 2.08, 95% CI: 1.41, 3.06), and significantly higher rates of death due to assault, suffocation, and fire were detected for specific age groups. Mapped results highlight regional disparities in PrYLL across the province, which may reflect higher Aboriginal populations in rural and remote areas. Crucially, these disparities underscore the need for community-specific injury prevention policies, particularly in regions with high PrYLL.

Fatal aspiration of foreign bodies in infants and children

PURPOSE

To investigate the frequency, circumstances, demographics and autopsy findings of infants and children dying as a result of foreign body aspiration.

METHODS

Retrospective review of autopsy cases in children aged between seven days and 18 years, at one specialist centre over a 16-year period, in which death was the result of aspiration of a foreign body.

RESULTS

Ten cases were identified out of a total autopsy population of 2165. Only one individual had an underlying diagnosis potentially contributing to aspiration. All but one case involved aspiration of food, with grapes being a feature of four cases. In cases with a prolonged survival interval, autopsy demonstrated bronchopneumonia and hypoxic-ischaemic encephalopathy. In the remaining cases autopsy findings were non-specific.

CONCLUSIONS

Fatal aspiration of a foreign body is rare in this population. The cases involve normal children who aspirate food, particularly grapes. There are typically minimal, non-specific findings at autopsy.

Suicidal ligature strangulation using gymnastics bands

Suicidal ligature strangulation is a rare event. The most important issue to solve in the investigation is whether it is a case of homicide or suicide. The characteristics of suicidal ligature strangulation are summarized by Koops and Brinkmann with the emphasis on the nature of the ligature instrument(s). In this article, we present two cases of self-strangulation with an almost identical modus operandi using gymnastics bands. The autopsy findings and the nature of the ligature in these cases are depicted and in good accordance with the described typical observations in suicidal cases. The importance of a broad medico-legal investigation is demonstrated.