FULL-LENGTH ORIGINAL RESEARCH
Sudden unexplained death in childhood: A comparison of cases with and without a febrile seizure history *Dale C. Hesdorffer, †‡Laura A. Crandall, ‡Daniel Friedman, and ‡Orrin Devinsky Epilepsia, 56(8):1294–1300, 2015 doi: 10.1111/epi.13066
SUMMARY
Dale Hesdorffer is an associate professor at the Gertrude H. Sergievsky Center and Department of Epidemiology at Columbia University.
Objective: We considered whether a subset of children with sudden unexplained death in childhood (SUDC) and a history of febrile seizures (FS) may parallel those in sudden unexpected death in epilepsy (SUDEP). The prevalence of a history of FS was examined, and factors that may distinguish SUDC cases with and without FS were described. Methods: Characteristics were assessed in 123 consecutive children with SUDC reported to the SUDC program (4/1/11-3/31/14) by their parents. Parental interview covered the decedent’s medical history, circumstances of death, environmental factors, cause of death, and family medical history. Features of SUDC cases were compared by FS history. Results: Overall, 31.7% of SUDC cases had a history of FS, among which 74.4% had simple FS. Compared to those without a history of FS, a history of FS was associated with a greater median age at death (p = 0.03) and death during the weekdays (p = 0.02). Terminal fever was similar in those with and without FS. The median time from FS to death was 6.0 months (interquartile range [IQR] 3.0–10.0). In all SUDC cases, prone position at death, death during sleep, and unwitnessed deaths predominated. Significance: There are parallels among SUDC, sudden infant deaths, and sudden unexpected death in epilepsy (SUDEP) with regard to prone position, unwitnessed deaths mostly during sleep, and male predominance. In children with SUDC and a history of FS, terminal fever may increase the risk for an unwitnessed terminal seizure. The greater than expected prevalence of a FS history and the proportion with terminal fever or illness in this cohort suggests that some SUDC deaths may be seizure related and therefore have potential commonalities with SUDEP. KEY WORDS: Sudden death, Seizures, Febrile.
Sudden unexplained death in children is divided into two groups: sudden unexpected infant deaths (SUID) before age 12 months, which includes but is not limited to sudden infant death syndrome (SIDS) and sudden unexplained death in childhood (SUDC) from 1 to Accepted May 27, 2015; Early View publication June 29, 2015. *Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A.; †SUDC Foundation, Herndon, Virginia, U.S.A.; and ‡Department of Neurology, Comprehensive Epilepsy Center, NYU Langone Medical Center, New York, New York, U.S.A. Address correspondence to Dale C. Hesdorffer, Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University, 630 West 168th Street, P&S Unit 16, New York, NY 10024, U.S.A. E-mail [email protected] Wiley Periodicals, Inc. © 2015 International League Against Epilepsy
18 years. The incidence of SIDS1,2 far exceeds that of SUDC, which is most common among children ages 1– 4 years. 1–5 Recent estimates from the Centers for Disease Control and Prevention (CDC) for 2005–2013 find SIDS is 50.7 to more than 600 times higher than SUDC (39.7–55.6 per 100,000 live births for SIDS vs. 0.1–1.4 per 100,000 children aged 1–4 years for SUDC).2 SUDC is defined as the sudden and unexpected death of a child that remains unexplained after a thorough case investigation has been conducted.6 It is a category of death that eludes forensic science and likely represents a heterogeneous group with various underlying causes of death. The true incidence of SUDC is unknown and may differ when academic forensic pathologists make a consensus determination of cause of death.7 This difference may
1294
1295 Sudden Unexplained Death in Childhood
Key Points • • •
Among cases of sudden unexpected death in children (SUDC), 31.7% had a history of febrile seizure (FS), among which 74.4% had simple FS. A history of FS was associated with a greater median age at death (p = 0.03) and death during the weekdays (p = 0.02). In all SUDC cases, prone position at death, death during sleep, and unwitnessed deaths predominated.
partially reflect exclusion of children over the age of 5 years for SUDC in some epidemiologic studies.5 Although the World Health Organization (WHO) has an International Classification of Diseases (ICD) code for SIDS, none exists for SUDC, and death certification is diverse across medical examiners and coroners. Therefore, understanding the occurrence of SUDC from U.S. death certificates alone is impossible, and our knowledge of SUDC is correspondingly limited. SUDC has been the subject of little medical research, even when its relative frequency is considered.8 Previous studies have found that SUDC is more common in male toddlers, aged 1 through 3 years, and most cases were born as full-term singletons.6,9 Although minor pathologic findings in the hippocampus have been found in some cases, they have not explained the deaths.9 Among reported SUDC cases, most are unwitnessed, occur during a sleep period, and the child is often found in the prone positon.6,9 Similar circumstances of death also occur in sudden unexplained infant death (SUID)/SIDS,10 sudden unexpected death in epilepsy (SUDEP), and in some deaths labeled as undetermined.11 In SUDEP, a seizure during sleep may trigger the pathophysiologic cascade leading to death,12 with most deaths unwitnessed and with the deceased found in the prone position. Childhood SUDEP accounts for 14% of all SUDEP.13 Although prone position at death is common among SUID/SIDS, SUDC, and SUDEP, the presence of a history of FS described by others6 led us to hypothesize that sudden unexplained death in a child with a history of FS may be seizure related. We determined the prevalence of a history of FS in an SUDC cohort self-referred to the SUDC Foundation, and examined factors that may distinguish SUDC cases with and without FS.
Methods The SUDC Foundation, formerly known as the SUDC Program within the CJ Foundation for SIDS, is a not-forprofit foundation. Its mission is to increase awareness, fund research on causes and prevention of SUDC, and provide
support and advocacy for families affected by these tragedies. Formed in 2001, it has collected data on more than 630 SUDC cases in the United States and abroad, overwhelmingly from English-speaking countries. We reviewed all cases reported to the SUDC Program between April 1, 2011 and March 31, 2014. This period was used because registration procedures changed from a brief parent/caregiver interview to a direct comprehensive interview with parents about the family unit and child who succumbed to an unexpected death. The SUDC Program intake form was administered via phone interview to 141 parents or guardians of deceased children between 1 and 16 years of age. Since April 2011, questions asked covered the birth and medical history of the decedent, family medical history including history of sudden death, syncope, epilepsy, and FS, as well as circumstances of the child’s death and environmental factors. Questions about environment included those considered possible risk factors of SUID/SIDS such as bed sharing, second hand smoke exposure, and sleep environment.14,15 History of FS: FS were defined as a seizure associated with illness or fever of ≥101°F, occurring in children older than 1 month.16 Children with prior unprovoked seizures, acute central nervous system infections, electrolyte imbalance, or other provoked events were excluded.17,18 Complex FS were defined as prolonged (>10 min) or focal or multiple during the febrile illness. Febrile status epilepticus, a subset of complex FS, were considered to be FS lasting 30 min or more. Simple FS were defined as single, short, nonfocal seizures.16 Demographics: Age at death, gender, and ethnicity were examined. Medical and social factors: We considered vaccination compliance up to death, early intervention, parental smoking during pregnancy, and postnatal smoking in the home environment. First-degree family history: First-degree family history of FS, other seizures, syncope, and sudden unexplained death was elucidated. Time of death: The day of death was divided into the weekend (Friday, Saturday, Sunday) and weekdays (Monday–Thursday). Season of death was examined. Circumstances of death: These were categorized according to whether the death occurred during a sleep period; whether it was unwitnessed; body position (i.e., prone, supine, or side); the direction of the face when discovered (i.e., face down, face to the side, or face up); sharing a sleep surface with an adult or another child; sleep environment (i.e., soft sleeping surface, and use of a pillow, a blanket, or a stuffed toy); and terminal fever or illness symptoms. Illness symptoms within 48 h of death included cold, stomach illness, ear infection, sore throat, cough, crankiness/lethargy/excessive crying, sweating, and appetite change. Epilepsia, 56(8):1294–1300, 2015 doi: 10.1111/epi.13066
1296 D. C. Hesdorffer et al. Table 1. Factors associated with SUDC with and without FS Factors Demographics Median age in months at death (IQR) Males, N (%) Ethnicity, N (%)a White Black Asian Hispanic Mixed/other Medical and social factors Vaccinations up to date at death, N (%)b Parent smoked during pregnancy, N (%)c Postnatal parental smoking at home, N (%)c Child received early intervention First-degree family history, N (%) FS Other seizures Syncopea Sudden death Circumstances of death Day of death, N (%) Weekday Weekend (Friday–Sunday) Season of death, N (%) Winter Spring Summer Fall Death during sleep, N (%) Unwitnessed death, N (%) Body position at death, N (%)d Prone Supine Side Don’t know Direction of face at death, N (%)e Down To one side Up Don’t know Bed sharing with adult/another child, N (%) Sleep surface at death, N (%)a Crib Toddler bed Twin bed Full bed King bed Couch Playpen Car seat Other/don’t know Sleeping conditions at death, N (%) Soft sleeping surfacef Pillowg Blanketg Stuffed toyg Terminal fever or illness symptoms in 48 h before death, N (%)
SUDC with FS (N = 39)
SUDC without FS (N = 84)
24.0 (19.0–31.0) 24 (61.5)
19.0 (15.0–25.5) 54 (64.3)
p-Value 0.03
All SUDC (N = 123) 20.0 (17.0–27.0) 78 (63.4)
ns 36 (92.3) 0 (0) 1 (2.6) 1 (2.6) 1 (2.6)
73 (87.9) 3 (3.6) 3 (3.6) 0 (0) 4 (4.8)
109 (89.3) 3 (2.5) 4 (3.3) 1 (0.8) 5 (4.1)
36 (92.3) 1 (2.8) 4 (11.1) 5 (12.8)
81 (98.8) 3 (5.7) 6 (11.3) 6 (7.1)
ns ns ns ns
117 (96.7) 4 (4.5) 10 (11.2) 11 (8.9)
11 (28.2) 7 (18.0) 1 (2.6) 0 (0)
12 (14.3) 5 (6.0) 3 (3.6) 0 (0)
ns 0.04 ns ns
23 (18.7) 12 (9.8) 4 (3.2) 0 (0)
27 (69.2) 12 (30.8)
40 (47.6) 44 (52.4)
20 (51.3) 5 (12.8) 5 (12.8) 9 (23.1) 38 (97.4) 37 (94.9)
35 (41.7) 15 (17.9) 15 (17.9) 19 (22.6) 81 (96.4) 82 (97.6)
31 (81.6) 0 (0) 5 (13.2) 2 (5.3)
54 (70.1) 12 (15.6) 7 (9.1) 4 (5.2)
21 (58.3) 9 (25.0) 0 (0) 6 (16.7) 1 (2.6)
37 (48.1) 17 (22.1) 10 (13.0) 13 (16.9) 9 (10.7)
21 (53.9) 6 (15.3) 3 (7.7) 1 (2.6) 0 (0) 2 (5.1) 2 (5.1) 0 (0) 4 (10.2)
44 (53.0) 3 (3.6) 4 (4.8) 10 (12.1) 2 (2.4) 2 (2.4) 8 (9.6) 2 (2.4) 8 (9.6)
2 (5.3) 16 (42.1) 22 (57.9) 15 (39.5) 30 (76.9)
13 (17.1) 26 (33.6) 39 (50.0) 21 (26.9) 63 (75.9)
0.02 67 (54.5) 56 (45.5) ns
ns ns ns
55 (44.7) 20 (16.3) 20 (16.3) 28 (22.7) 119 (96.8) 119 (96.8) 85 (73.9) 12 (10.4) 12 (10.4) 6 (5.2)
ns
ns ns
58 (51.3) 26 (23.0) 10 (8.9) 19 (16.8) 10 (8.1) 65 (53.3) 9 (7.4) 7 (5.7) 11 (9.0) 2 (1.6) 4 (3.3) 10 (8.2) 2 (1.6) 10 (9.8)
ns
ns
15 (13.2) 42 (36.2) 61 (52.6) 36 (31.0) 93 (75.6) Continued
Epilepsia, 56(8):1294–1300, 2015 doi: 10.1111/epi.13066
1297 Sudden Unexplained Death in Childhood Table 1. Continued. Factors Factors related to FS Median age in months at first FS (IQR) FS type history, N (%) Simple Complex Both FS type unknown Median duration (min) of the longest FS (IQR) Rescue medications available, N (%)h Median time (months) from FS to death (IQR)
SUDC with FS (N = 39)
SUDC without FS (N = 84)
13.5 (11.0–18.0)
NA
29 (74.4) 5 (12.8) 3 (7.7) 2 (5.1) 2 (1.0–5.0) 5 (15.2) 6.0 (3.0–10.0)
NA NA NA NA NA NA NA
p-Value NA NA NA NA NA NA NA NA NA
All SUDC (N = 123) NA 29 (23.6) 5 (4.1) 3 (2.4) 2 (1.6) NA NA NA
FS, febrile seizures; IQR, interquartile range; SUDC, sudden unexpected death in childhood. a Missing 1 without FS. b Missing 2 without FS. c Missing 3 with FS and 31 without FS. d Missing 1 with FS and 7 without FS. e Missing 3 with FS and 7 without FS. f Missing 1 with FS and 8 without FS. g Missing 1 with FS and 6 without FS. h Missing 6 with FS.
Consent Parents seeking services through the SUDC Program provided written agreement for release of de-identified data for research. The New York University institutional review board considered this study exempt. Statistical analysis Frequencies and percentages summarized categorical variables. Continuous variables were reported as medians and interquartile ranges (IQRs). We compared the distribution of factors between cases with a history of FS and those without, using chi-square test for categorical variables and Wilcoxon’s test for continuous variables.
with a pillow, 52.6% with a blanket, and 31.0% with a stuffed toy. Bed sharing with an adult or another child was relatively rare, occurring in
Sudden unexplained death in childhood: A comparison of cases with and without a febrile seizure history *Dale C. Hesdorffer, †‡Laura A. Crandall, ‡Daniel Friedman, and ‡Orrin Devinsky Epilepsia, 56(8):1294–1300, 2015 doi: 10.1111/epi.13066
SUMMARY
Dale Hesdorffer is an associate professor at the Gertrude H. Sergievsky Center and Department of Epidemiology at Columbia University.
Objective: We considered whether a subset of children with sudden unexplained death in childhood (SUDC) and a history of febrile seizures (FS) may parallel those in sudden unexpected death in epilepsy (SUDEP). The prevalence of a history of FS was examined, and factors that may distinguish SUDC cases with and without FS were described. Methods: Characteristics were assessed in 123 consecutive children with SUDC reported to the SUDC program (4/1/11-3/31/14) by their parents. Parental interview covered the decedent’s medical history, circumstances of death, environmental factors, cause of death, and family medical history. Features of SUDC cases were compared by FS history. Results: Overall, 31.7% of SUDC cases had a history of FS, among which 74.4% had simple FS. Compared to those without a history of FS, a history of FS was associated with a greater median age at death (p = 0.03) and death during the weekdays (p = 0.02). Terminal fever was similar in those with and without FS. The median time from FS to death was 6.0 months (interquartile range [IQR] 3.0–10.0). In all SUDC cases, prone position at death, death during sleep, and unwitnessed deaths predominated. Significance: There are parallels among SUDC, sudden infant deaths, and sudden unexpected death in epilepsy (SUDEP) with regard to prone position, unwitnessed deaths mostly during sleep, and male predominance. In children with SUDC and a history of FS, terminal fever may increase the risk for an unwitnessed terminal seizure. The greater than expected prevalence of a FS history and the proportion with terminal fever or illness in this cohort suggests that some SUDC deaths may be seizure related and therefore have potential commonalities with SUDEP. KEY WORDS: Sudden death, Seizures, Febrile.
Sudden unexplained death in children is divided into two groups: sudden unexpected infant deaths (SUID) before age 12 months, which includes but is not limited to sudden infant death syndrome (SIDS) and sudden unexplained death in childhood (SUDC) from 1 to Accepted May 27, 2015; Early View publication June 29, 2015. *Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University, New York, New York, U.S.A.; †SUDC Foundation, Herndon, Virginia, U.S.A.; and ‡Department of Neurology, Comprehensive Epilepsy Center, NYU Langone Medical Center, New York, New York, U.S.A. Address correspondence to Dale C. Hesdorffer, Gertrude H. Sergievsky Center and Department of Epidemiology, Columbia University, 630 West 168th Street, P&S Unit 16, New York, NY 10024, U.S.A. E-mail [email protected] Wiley Periodicals, Inc. © 2015 International League Against Epilepsy
18 years. The incidence of SIDS1,2 far exceeds that of SUDC, which is most common among children ages 1– 4 years. 1–5 Recent estimates from the Centers for Disease Control and Prevention (CDC) for 2005–2013 find SIDS is 50.7 to more than 600 times higher than SUDC (39.7–55.6 per 100,000 live births for SIDS vs. 0.1–1.4 per 100,000 children aged 1–4 years for SUDC).2 SUDC is defined as the sudden and unexpected death of a child that remains unexplained after a thorough case investigation has been conducted.6 It is a category of death that eludes forensic science and likely represents a heterogeneous group with various underlying causes of death. The true incidence of SUDC is unknown and may differ when academic forensic pathologists make a consensus determination of cause of death.7 This difference may
1294
1295 Sudden Unexplained Death in Childhood
Key Points • • •
Among cases of sudden unexpected death in children (SUDC), 31.7% had a history of febrile seizure (FS), among which 74.4% had simple FS. A history of FS was associated with a greater median age at death (p = 0.03) and death during the weekdays (p = 0.02). In all SUDC cases, prone position at death, death during sleep, and unwitnessed deaths predominated.
partially reflect exclusion of children over the age of 5 years for SUDC in some epidemiologic studies.5 Although the World Health Organization (WHO) has an International Classification of Diseases (ICD) code for SIDS, none exists for SUDC, and death certification is diverse across medical examiners and coroners. Therefore, understanding the occurrence of SUDC from U.S. death certificates alone is impossible, and our knowledge of SUDC is correspondingly limited. SUDC has been the subject of little medical research, even when its relative frequency is considered.8 Previous studies have found that SUDC is more common in male toddlers, aged 1 through 3 years, and most cases were born as full-term singletons.6,9 Although minor pathologic findings in the hippocampus have been found in some cases, they have not explained the deaths.9 Among reported SUDC cases, most are unwitnessed, occur during a sleep period, and the child is often found in the prone positon.6,9 Similar circumstances of death also occur in sudden unexplained infant death (SUID)/SIDS,10 sudden unexpected death in epilepsy (SUDEP), and in some deaths labeled as undetermined.11 In SUDEP, a seizure during sleep may trigger the pathophysiologic cascade leading to death,12 with most deaths unwitnessed and with the deceased found in the prone position. Childhood SUDEP accounts for 14% of all SUDEP.13 Although prone position at death is common among SUID/SIDS, SUDC, and SUDEP, the presence of a history of FS described by others6 led us to hypothesize that sudden unexplained death in a child with a history of FS may be seizure related. We determined the prevalence of a history of FS in an SUDC cohort self-referred to the SUDC Foundation, and examined factors that may distinguish SUDC cases with and without FS.
Methods The SUDC Foundation, formerly known as the SUDC Program within the CJ Foundation for SIDS, is a not-forprofit foundation. Its mission is to increase awareness, fund research on causes and prevention of SUDC, and provide
support and advocacy for families affected by these tragedies. Formed in 2001, it has collected data on more than 630 SUDC cases in the United States and abroad, overwhelmingly from English-speaking countries. We reviewed all cases reported to the SUDC Program between April 1, 2011 and March 31, 2014. This period was used because registration procedures changed from a brief parent/caregiver interview to a direct comprehensive interview with parents about the family unit and child who succumbed to an unexpected death. The SUDC Program intake form was administered via phone interview to 141 parents or guardians of deceased children between 1 and 16 years of age. Since April 2011, questions asked covered the birth and medical history of the decedent, family medical history including history of sudden death, syncope, epilepsy, and FS, as well as circumstances of the child’s death and environmental factors. Questions about environment included those considered possible risk factors of SUID/SIDS such as bed sharing, second hand smoke exposure, and sleep environment.14,15 History of FS: FS were defined as a seizure associated with illness or fever of ≥101°F, occurring in children older than 1 month.16 Children with prior unprovoked seizures, acute central nervous system infections, electrolyte imbalance, or other provoked events were excluded.17,18 Complex FS were defined as prolonged (>10 min) or focal or multiple during the febrile illness. Febrile status epilepticus, a subset of complex FS, were considered to be FS lasting 30 min or more. Simple FS were defined as single, short, nonfocal seizures.16 Demographics: Age at death, gender, and ethnicity were examined. Medical and social factors: We considered vaccination compliance up to death, early intervention, parental smoking during pregnancy, and postnatal smoking in the home environment. First-degree family history: First-degree family history of FS, other seizures, syncope, and sudden unexplained death was elucidated. Time of death: The day of death was divided into the weekend (Friday, Saturday, Sunday) and weekdays (Monday–Thursday). Season of death was examined. Circumstances of death: These were categorized according to whether the death occurred during a sleep period; whether it was unwitnessed; body position (i.e., prone, supine, or side); the direction of the face when discovered (i.e., face down, face to the side, or face up); sharing a sleep surface with an adult or another child; sleep environment (i.e., soft sleeping surface, and use of a pillow, a blanket, or a stuffed toy); and terminal fever or illness symptoms. Illness symptoms within 48 h of death included cold, stomach illness, ear infection, sore throat, cough, crankiness/lethargy/excessive crying, sweating, and appetite change. Epilepsia, 56(8):1294–1300, 2015 doi: 10.1111/epi.13066
1296 D. C. Hesdorffer et al. Table 1. Factors associated with SUDC with and without FS Factors Demographics Median age in months at death (IQR) Males, N (%) Ethnicity, N (%)a White Black Asian Hispanic Mixed/other Medical and social factors Vaccinations up to date at death, N (%)b Parent smoked during pregnancy, N (%)c Postnatal parental smoking at home, N (%)c Child received early intervention First-degree family history, N (%) FS Other seizures Syncopea Sudden death Circumstances of death Day of death, N (%) Weekday Weekend (Friday–Sunday) Season of death, N (%) Winter Spring Summer Fall Death during sleep, N (%) Unwitnessed death, N (%) Body position at death, N (%)d Prone Supine Side Don’t know Direction of face at death, N (%)e Down To one side Up Don’t know Bed sharing with adult/another child, N (%) Sleep surface at death, N (%)a Crib Toddler bed Twin bed Full bed King bed Couch Playpen Car seat Other/don’t know Sleeping conditions at death, N (%) Soft sleeping surfacef Pillowg Blanketg Stuffed toyg Terminal fever or illness symptoms in 48 h before death, N (%)
SUDC with FS (N = 39)
SUDC without FS (N = 84)
24.0 (19.0–31.0) 24 (61.5)
19.0 (15.0–25.5) 54 (64.3)
p-Value 0.03
All SUDC (N = 123) 20.0 (17.0–27.0) 78 (63.4)
ns 36 (92.3) 0 (0) 1 (2.6) 1 (2.6) 1 (2.6)
73 (87.9) 3 (3.6) 3 (3.6) 0 (0) 4 (4.8)
109 (89.3) 3 (2.5) 4 (3.3) 1 (0.8) 5 (4.1)
36 (92.3) 1 (2.8) 4 (11.1) 5 (12.8)
81 (98.8) 3 (5.7) 6 (11.3) 6 (7.1)
ns ns ns ns
117 (96.7) 4 (4.5) 10 (11.2) 11 (8.9)
11 (28.2) 7 (18.0) 1 (2.6) 0 (0)
12 (14.3) 5 (6.0) 3 (3.6) 0 (0)
ns 0.04 ns ns
23 (18.7) 12 (9.8) 4 (3.2) 0 (0)
27 (69.2) 12 (30.8)
40 (47.6) 44 (52.4)
20 (51.3) 5 (12.8) 5 (12.8) 9 (23.1) 38 (97.4) 37 (94.9)
35 (41.7) 15 (17.9) 15 (17.9) 19 (22.6) 81 (96.4) 82 (97.6)
31 (81.6) 0 (0) 5 (13.2) 2 (5.3)
54 (70.1) 12 (15.6) 7 (9.1) 4 (5.2)
21 (58.3) 9 (25.0) 0 (0) 6 (16.7) 1 (2.6)
37 (48.1) 17 (22.1) 10 (13.0) 13 (16.9) 9 (10.7)
21 (53.9) 6 (15.3) 3 (7.7) 1 (2.6) 0 (0) 2 (5.1) 2 (5.1) 0 (0) 4 (10.2)
44 (53.0) 3 (3.6) 4 (4.8) 10 (12.1) 2 (2.4) 2 (2.4) 8 (9.6) 2 (2.4) 8 (9.6)
2 (5.3) 16 (42.1) 22 (57.9) 15 (39.5) 30 (76.9)
13 (17.1) 26 (33.6) 39 (50.0) 21 (26.9) 63 (75.9)
0.02 67 (54.5) 56 (45.5) ns
ns ns ns
55 (44.7) 20 (16.3) 20 (16.3) 28 (22.7) 119 (96.8) 119 (96.8) 85 (73.9) 12 (10.4) 12 (10.4) 6 (5.2)
ns
ns ns
58 (51.3) 26 (23.0) 10 (8.9) 19 (16.8) 10 (8.1) 65 (53.3) 9 (7.4) 7 (5.7) 11 (9.0) 2 (1.6) 4 (3.3) 10 (8.2) 2 (1.6) 10 (9.8)
ns
ns
15 (13.2) 42 (36.2) 61 (52.6) 36 (31.0) 93 (75.6) Continued
Epilepsia, 56(8):1294–1300, 2015 doi: 10.1111/epi.13066
1297 Sudden Unexplained Death in Childhood Table 1. Continued. Factors Factors related to FS Median age in months at first FS (IQR) FS type history, N (%) Simple Complex Both FS type unknown Median duration (min) of the longest FS (IQR) Rescue medications available, N (%)h Median time (months) from FS to death (IQR)
SUDC with FS (N = 39)
SUDC without FS (N = 84)
13.5 (11.0–18.0)
NA
29 (74.4) 5 (12.8) 3 (7.7) 2 (5.1) 2 (1.0–5.0) 5 (15.2) 6.0 (3.0–10.0)
NA NA NA NA NA NA NA
p-Value NA NA NA NA NA NA NA NA NA
All SUDC (N = 123) NA 29 (23.6) 5 (4.1) 3 (2.4) 2 (1.6) NA NA NA
FS, febrile seizures; IQR, interquartile range; SUDC, sudden unexpected death in childhood. a Missing 1 without FS. b Missing 2 without FS. c Missing 3 with FS and 31 without FS. d Missing 1 with FS and 7 without FS. e Missing 3 with FS and 7 without FS. f Missing 1 with FS and 8 without FS. g Missing 1 with FS and 6 without FS. h Missing 6 with FS.
Consent Parents seeking services through the SUDC Program provided written agreement for release of de-identified data for research. The New York University institutional review board considered this study exempt. Statistical analysis Frequencies and percentages summarized categorical variables. Continuous variables were reported as medians and interquartile ranges (IQRs). We compared the distribution of factors between cases with a history of FS and those without, using chi-square test for categorical variables and Wilcoxon’s test for continuous variables.
with a pillow, 52.6% with a blanket, and 31.0% with a stuffed toy. Bed sharing with an adult or another child was relatively rare, occurring in
