When a complete investigation, including an autopsy, review of the clinical history and evaluation of the scene, does not allow for identification of a specific manner of death, or there are competing manners of death, the death will be classified as undetermined.  Most paediatric deaths that are classified as undetermined occur in children under one year of age, with a smaller proportion occurring in children aged one to five and even fewer in the older age groups.

Chart 16 illustrates the number of undetermined deaths by age group, with and without Society involvement prior to the death in 2018.  Most paediatric deaths that are classified as undetermined occur in children under one year of age, with a smaller proportion occurring in children in older age groups.

Chart 16: Paediatric deaths Classified as undetermined – with or without Society involvement in 2018 cn=80)

Chart 16: Most undeterminded deaths occur in children under one, and a smaller proportion occur in older age groups.

 

Presence of sleep associated circumstance as a potential contributing factor in undetermined deaths

In 2018, sleep circumstances were identified in 48% (38) of the 80 paediatric deaths where the manner of death was classified as undetermined.  Of the paediatric deaths where sleep circumstances were identified as a factor, 47% (n=18) of these children or their families received services from a Society within 12 months of their death.

While the data demonstrates a statistically significant difference in the number of deaths of children with and without Society involvement where the manner was undetermined, when considering only those cases where sleep circumstances were identified as potential contributing factors to the death there was no significant difference between Society involved and non-Society involved populations (a Fisher’s exact test was performed.  The relation between the variables was not significant, p = 0.187). This is consistent with the findings of previous years.  Analysis of a six-year cohort did not identify a statistically significant difference (a Fisher’s exact test was performed.  The relation between the variables was not significant, p = 0.121).  The number of deaths of children with Society involvement where sleep circumstances were identified as a potential contributing factor has been decreasing since this type of data analysis began in 2014, although in 2018 there was a slight rise in these cases.

As noted in previous annual reports, many variables require consideration when interpreting this finding. First and foremost, the small sample size must be considered.  In addition, Societies are not the only organizations promoting safe sleep in communities. The independent impact of Society practice on the number of paediatric deaths occurring in unsafe sleep environments is unknown; however, the continued absence of a significant difference between Society involved deaths and those without Society involvement may suggest that the practices of Societies have potentially contributed to the overall prevention of paediatric deaths where sleep environment may be factor.