Evaluation of Concordance Between Original Death Certifications and an Expert Panel Process in the Determination of Sudden Unexplained Death in Childhood

Key Points Question Does the US death investigation system underestimate the frequency of sudden unexplained death in childhood (SUDC)? Findings In this case series of the SUDC Registry and Research Collaborative, 2 forensic pathologists from a pool of 13 independently reviewed 100 cases of SUDC. These reviewers were discordant with the original certifier’s cause of death opinion in 40% of cases, including 28 cases originally considered accidental or natural but adjudicated as unexplained by our review. Meaning This study suggests that the US Centers for Disease Control and Prevention underestimates the rate of SUDC and that there is a low rate of consistency in death certification of sudden unexpected pediatric deaths.