Incidence of SUDC likely higher than previously thought


Sudden unexplained death in childhood (SUDC) is a leading category of death for toddlers, but a new report indicates that we may be underestimating the incidence of SUDC.

The death of a child is always difficult, but the inexplicable nature of sudden unexplained death in childhood (SUDC) is extremely difficult. It’s the fifth leading category of death for toddlers, according to the Centers for Disease Control and Prevention (CDC), but a new report in JAMA Network Open examines whether the current death investigation system is actually finding every case of SUDC that occurs in the United States.1

For this report, a team of 13 forensic pathologists were used to examine 100 cases that had been enrolled in the SUDC Registry and Research Collaborative (SUDCRRC). Each case involved a child who died aged 11 months to 18 years. The child had lived in Canada, the United Kingdom, or one of 36 states in the United States. The child was posthumously enrolled into SUDCRRC by family from 2014 to 2017. Each case was independently reviewed by 2 of the forensic scientists. Investigators also looked at the data from clinical offices, family members, and the medicolegal investigative offices that had classified the death initially.

Of the 100 cases of SDC, the average age was 32.1 months. Most of the children were white and 92 of the cases occurred in the United States. Among these cases, the original medicolegal investigators had certified that 43 of the cases had an explainable cause of death and 57 of the cases were ruled as unexplained cause of death. Following review by the SUDCRRC, the certifications shifted among the 100 cases. Seven of the cases had undetermined causes of death because there were insufficient data. Sixteen of the deaths were found to have an explainable cause of death, but the majority of the cases, 77 in total, were found to have unexplained cause of death. Moreover, the experts who looked at the cases did not agree with the original cause of death noted in 40 of the re-examined cases.

The investigators concluded that the SUDC incidence is likely higher that the current estimate from the CDC, which was 392 deaths in 2018. They noted that some cases of SUDC could be incorrectly attributed to either natural or accidental cause of death, which could impact research, public health funding, and surveillance for SUDC. Additionally, it could have a n impact on the medical care of surviving family members.


1. Crandall L, Lee J, Friedman D, et al. Evaluation of concordance between original death certifications and an expert panel process in the determination of sudden unexplained death in childhood. JAMA Netw Open. 2020;3(10):e2023262. doi:10.1001/jamanetworkopen.2020.23262

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