A survey of medical examiner death certification of vignettes on death in epilepsy: Gaps in identifying SUDEP

Dead in the water: Epilepsy‐related drowning or sudden unexpected death in epilepsy?

“…Our results suggest that it is often difficult to distinguish drowning deaths in SUDEP based on postmortem findings. Studies have shown that the incidence of SUDEP is probably underestimated because of the underrecognition by medical examiners, coroners, and physicians and because of misclassification of the cause of death . There are many reasons for this underestimate, but some may include attributing death to another cause based on minor autopsy findings (eg, mild atherosclerosis and coronary artery disease), toxicology results (eg, positive screen for opiates in a decedent with chronic opioid use and drug overdose), and death scene findings (eg, death in an empty bathtub and drowning).…”

“…Studies have shown that the incidence of SUDEP is probably underestimated because of the underrecognition by medical examiners, coroners, and physicians and because of misclassification of the cause of death. [27][28][29] There are many reasons for this underestimate, but some may include attributing death to another cause based on minor autopsy findings (eg, mild atherosclerosis and coronary artery disease), toxicology results (eg, positive screen for opiates in a decedent with chronic opioid use and drug overdose), and death scene findings (eg, death in an empty bathtub and drowning). As both drowning and SUDEP are pathological diagnoses of exclusion, it is understandable that a death could be erroneously attributed to drowning based on F I G U R E 2 Distribution of combined lung weights of the cases in the three groups.…”

Serotonin reuptake inhibitors and mortality in epilepsy: A linked primary‐care cohort study

“…In particular, seizure-related death may be inaccurately or simply undercoded. 32,33 Therefore, we made the a priori decision to expand the definition to include the CALIBER codes for sudden death and ICD-9/10 codes for unknown/unspecified death (Appendix S1). This was predicated on the fact that a cardiovascular etiology is often the default assumed cause of death in otherwise healthy people with epilepsy.…”

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

“…Investigators with the same data reach different conclusions based on their location, training, and preferences. 19 , 20 …”