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However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>All cases of asphyxia in children and adolescents (0\u201321\u00a0years of age) among the Hamburg Legal Medical Department\u2019s autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Among 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15\u201321\u00a0years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Asphyxia in children and adolescents often involves accidents. 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