{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T04:28:59Z","timestamp":1786422539762,"version":"build-2736575974"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Sudden Unexplained Death in Youth (SUDY) requires thorough investigation to identify underlying causes and guide prevention strategies. In the Netherlands, cases are investigated using the standardized Postmortem Evaluation of Sudden Unexplained Death in Infants and Children (PESUDIC), in which autopsy is offered as a standard component. However, its invasive nature and associated time burden may limit parental acceptance. This study evaluated to what extent the cause of death can be established using a limited set of diagnostic tests compared to the standard procedure including autopsy. In this observational study, children\u2009&gt;\u20092\u00a0years of age who died suddenly and unexpectedly and underwent PESUDIC, including imaging and autopsy, were included. Two expert panels, consisting of a forensic and a pediatric specialist, independently assessed early diagnostic tests available before autopsy. Cases were classified by level of diagnostic certainty and need for autopsy. Panel conclusions were compared with the reference standard: a multidisciplinary audit incorporating all available information, including autopsy findings. Sixty-six cases were included (median age 12\u00a0years (IQR 4\u201314.7), 63% male). Panels identified indicative information for a cause of death in 60 patients (91%). Nevertheless, autopsy was required in most cases (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200959) to confirm the diagnosis. In 7 cases (10.6%), panels were sufficiently confident to establish the cause of death without autopsy with complete agreement with the reference standard. Causes included obstructive gastrointestinal pathology (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20095) and diabetic ketoacidosis with dehydration (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    :\u00a0Only a small proportion of children\u2009&gt;\u20092\u00a0years of age with sudden unexpected death have a cause of death that can be established with sufficient certainty at an early stage. In the vast majority of cases, the cause of death remains uncertain, supporting the recommendation to perform an autopsy.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Autopsy in sudden unexplained death in youth is worldwide recognized as the gold standard for postmortem examination. However, its invasive nature and associated time burden may limit parental acceptance.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>In 7 of 60 sudden and unexplained deceased minors (10%), sufficient certainty regarding the cause of death can be obtained by other minimal invasive diagnostic test, so without the need of an autopsy. Causes without the need of an autopsy included obstructive gastrointestinal pathology and diabetic ketoacidosis with dehydration.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07286-7","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T16:19:26Z","timestamp":1785601166000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Autopsy in sudden unexplained death in youth: indispensable or in some cases redundant? An observational study"],"prefix":"10.1007","volume":"185","author":[{"given":"A. C.","family":"van der Gugten","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. M.","family":"Wemeijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. A.","family":"Semmekrot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. B. J.","family":"Smit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Oostdam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. L. J. M.","family":"Duijst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"de Gier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"van de Putte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PESUDIC collaborative","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Custers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Edelenbos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Fuijkschot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Levelink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.J.","family":"Puiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.R","family":"van Rijn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.M.","family":"Ruskamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.A.","family":"Semmekrot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.T.","family":"Verbruggen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Vlaardingerbroek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.E.","family":"Wiesman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"issue":"12","key":"7286_CR1","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1097\/PEC.0000000000003074","volume":"39","author":"MH Wojcik","year":"2023","unstructured":"Wojcik MH, Krous HF, Goldstein RD (2023) Sudden unexplained death in childhood: current understanding. Pediatr Emerg Care 39(12):979\u2013983","journal-title":"Pediatr Emerg Care"},{"key":"7286_CR2","unstructured":"Centraal Bureau Statistiek (n.d.) CBS Statline Overledenen; doodsoorzaak (uitgebreide lijst), leeftijd, geslacht 2022 (Updated 23\u201306\u2013 2022). Available from:\u00a0https:\/\/opendata.cbs.nl\/#\/CBS\/nl\/dataset\/7233\/table?ts=1656511974367"},{"key":"7286_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2023.113780","volume":"264","author":"AM Pries","year":"2024","unstructured":"Pries AM, Ruskamp JM, Edelenbos E, Fuijkschot J, Semmekrot B, Verbruggen KT et al (2024) A systematic approach to evaluate sudden unexplained death in children. J Pediatr 264:113780","journal-title":"J Pediatr"},{"key":"7286_CR4","unstructured":"PWC. NODO-evaluatieonderzoek: Onderzoek naar de effectiviteit van de NODO-procedure in het achterhalen van de aard van het onverwacht en onverklaard overlijden van minderjarigen in Nederland. 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J Trop Pediatr 51(3):131\u2013135. https:\/\/doi.org\/10.1093\/tropej\/fmh099","journal-title":"J Trop Pediatr"},{"issue":"11","key":"7286_CR9","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1111\/j.1600-0412.2011.01202.x","volume":"90","author":"C Holste","year":"2011","unstructured":"Holste C, Pilo C, Pettersson K, Radestad I, Papadogiannakis N (2011) Mothers\u2019attitudes towards perinatal autopsy after stillbirth. Acta Obstet Gynecol Scand 90(11):1287\u201390","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"3","key":"7286_CR10","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/birt.12344","volume":"45","author":"A Schirmann","year":"2018","unstructured":"Schirmann A, Boyle FM, Horey D, Siassakos D, Ellwood D et al (2018) Understanding mothers\u2019decision-making needs for autopsy consent after stillbirth: framework analysis of a large survey. Birth 45(3):255\u2013262","journal-title":"Birth"},{"issue":"4","key":"7286_CR11","doi-asserted-by":"publisher","first-page":"e1013","DOI":"10.1542\/peds.2009-2027","volume":"127","author":"J Sullivan","year":"2011","unstructured":"Sullivan J, Monagle P (2011) Bereaved parents\u2019perceptions of the autopsy examination of their child. Pediatrics 127(4):e1013. https:\/\/doi.org\/10.1542\/peds.2009-2027","journal-title":"Pediatrics"},{"key":"7286_CR12","unstructured":"Wemeijer TM, van der Gugten AC et al (2026) Onderzoek doodsoorzaak bij onverwacht overlijden kind. Ervaringen van ouders met de NODOK-procedure. 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NODOK-Handelingsprotocol-2024.pdf"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07286-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-07286-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-07286-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:49:43Z","timestamp":1786420183000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-07286-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":17,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["7286"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-07286-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-9452325\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]},"assertion":[{"value":"17 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study proposal was reviewed by the Medical Research Ethics Committee of the University Medical Center Utrecht (reference number 18\u2013174\/C). The committee issued a statement confirming that this study does not fall under the Dutch Medical Research Involving Human Subjects Act.","order":2,"name":"Ethics","label":"Medical ethical review","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"632"}}