• B A S van Zaane, J B M van Woensel, A H Teeuw, A Maes, and A P Bos.
• Academisch Medisch Centrum/Universiteit van Amsterdam, locatie Emma Kinderziekenhuis, afd. Intensive Care Kinderen, G8ZW, Postbus 22.660, 1100 DD Amsterdam.
• Ned Tijdschr Geneeskd. 2004 Aug 7;148(32):1591-4.

ObjectiveTo analyse the causes of unnatural death in a general paediatric intensive-care unit.DesignRetrospective and descriptive.MethodsThe cause of death was reviewed for all deceased children who were admitted to the paediatric intensive-care unit of the Emma Children's Hospital/Academic Medical Centre in Amsterdam, the Netherlands from 1993 through 2002. Three investigators independently categorised the cause of death as 'natural' or 'unnatural'. Unnatural death was defined as death by external cause, such as drowning, suffocation or violence, whether intentional or not. For all patients who died an unnatural death the cause of death and (if available) results of autopsy were analysed.ResultsDuring the study period, 5523 patients were admitted to the ICU, of whom 360 (6.5%) died during the period of admission. In 45 (12.5%) of these this was an unnatural death. In 7 (16%) patients there was a suspicion of death by deliberately caused injury. In 4 of these patients forensic autopsy was performed. The results of autopsy confirmed the suspicion of child battery in 3 patients, whereas in 1 case the diagnosis was refuted.ConclusionIn 16% of the children who died of unnatural causes there was a suspicion of child battery. A forensic autopsy was useful in all cases to confirm or refute the suspicion of child battery, but was not carried out in all cases.

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