title: Differences in investigations of sudden unexpected deaths in young people in a nationwide setting.
abstract: BACKGROUND
  Inherited disease may be causative in many young sudden unexpected death cases. Autopsy is essential in the counselling of the bereaved, as the family of the victim may be at risk too. In a nationwide setting operating under the same set of laws, we hypothesized that regional differences exist in the investigation of young persons dying suddenly and unexpectedly.
  
  
  RESULTS
  All deaths in persons aged 1-35 years in Denmark in 2000-2006 were included. Death certificates were read independently by two physicians. External examination as well as autopsy status was retrieved. Significant regional differences were found regarding external examinations and autopsy frequencies. Ratios of conducted external examinations varied between 63% and 93% (p = 0.004). Autopsy ratios varied between 60% and 88% (p = 0.001). In urban areas, external examinations and autopsies were more often conducted than in rural areas. In East Denmark, there were more external examinations resulting in a forensic autopsy, and there was a higher overall autopsy rate compared to West Denmark.
  
  
  CONCLUSIONS
  Despite operating under the same set of laws, we document significant regional differences in forensic investigations of young persons suffering a sudden unexpected death. This is probably not unique for Denmark although no data exist to confirm that. The results are worrying and call for a revision of the way these deaths are handled. Mandatory autopsy in sudden unexpected death in young persons is warranted as a thorough investigation of the death may help the clinician in guidance of the relatives in relation to hereditary diseases.
authors.affiliation: The Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark. bowinkel@dadlnet.dk
authors.forename: Bo Gregers
authors.initials: BG
authors.lastname: Winkel
authors.forename: Anders Gaarsdal
authors.initials: AG
authors.lastname: Holst
authors.forename: Juliane
authors.initials: J
authors.lastname: Theilade
authors.forename: Ingrid Bayer
authors.initials: IB
authors.lastname: Kristensen
authors.forename: Jørgen Lange
authors.initials: JL
authors.lastname: Thomsen
authors.forename: Hans Petter
authors.initials: HP
authors.lastname: Hougen
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.forename: Jacob
authors.initials: J
authors.lastname: Tfelt-Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003645:Death, Sudden / Q000453:epidemiology / Q000473:pathology*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D055815:Young Adult