Sudden death in children with gastrointestinal diseases. 24 forensic cases

Abstract

During the period 1963-1986, 24 fatal cases of gastrointestinal disease in children aged 0-14 years were referred to the Institute of Forensic Medicine, Aarhus, Denmark, for autopsy. We have retrospectively, reviewed the cases and asked the medical officers of health, whether complaints against doctors or hospitals for negligence had been raised. The material consists of 19 boys and 5 girls with 9 different gastrointestinal diagnoses, predominantly small intestinal obstructive diseases such as intussuception, volvolus and adhesions. Five children with gastroenteritis were included who were treated and died at home. Reported prodromal symptoms were present in 23 of 24 cases. Nineteen had contacted a doctor in the week preceding death. The number of consultations ranged from 1 to 3 and involved general practitioners predominantly. Among 14 of 19 cases where death occurred at home, a doctor had been called prior to the death of the child. In 12 cases the clinical diagnoses were different from the autopsy results. The most frequent wrong clinical diagnosis was gastroenteritis. After the autopsies, five cases were reported to the National Board of Health for further consideration. In four cases the National Board of Health stated that negligence had existed. From our investigations and research from elsewhere it appeared that the National Board of Health defines negligence as considerable error of judgement, or where examination or history raking, had been insufficient. The main purpose is to prevent these gastrointestinal deaths. Attention has been drawn, in particular, to the small intestinal obstructive diseases and dehydration following gastroenteritis.