Findings in child deaths registered as sudden infant death syndrome (SIDS) in Madison, Wisconsin.

A review of a sequential series has been carried out on 60 Madison infants whose deaths had been registered as SIDS. In 18% it was possible to identify lesions that could have given a diagnosis other than SIDS on these same infants. When the cases were assessed on a multifactorial basis, 67% of the infants had a variety of lesions present, which in combination would probably have made their deaths explicable. It was only in children dying before the age of 18 weeks that more than half of the deaths were not explicable. The generally accepted concept of SIDS as a completely unexplained death would appear to apply only if the term is confined to a single aspect of pathology--the terminal anatomic state. If the total pathologic situation of the child is taken into consideration, the diagnosis of a completely unexplained death applies to only about a third of the cases examined in Madison. The current autopsy approach to sudden and unexpected deaths from a causal viewpoint requires critical reappraisal.