Sudden unexpected death in children and adolescents

To determine the incidence and clinicopathologic spectrum of sudden unexpected death, we reviewed the death certificate of all residents of Olmsted County, Minnesota who were between 1 and 22 years of age when they died during the period from January 1950 to October 1982. Of 515 death certificates reviewed, 12 (2.3%) recorded sudden unexpected death, resulting in an incidence of 1.3 per 100,000 patient-years. The subjects ranged in age from 3 to 20 years (median 13); 8 of the 12 were male. Of the 12 deaths, 4 were definitely cardiac-related and 3 were probably cardiac-related. In the five other cases, the cause of death was unknown. Three of the 12 subjects had a history of syncope; 2 of the 3 had syncope associated with exercise, and both died while exercising. The relative rarity of sudden unexpected death in children and adolescents probably precludes population screening techniques to identify subjects at risk. However, a subset of subjects with 1) exercise-associated syncope, 2) nonvasodepressor syncope, 3) a family history of sudden unexpected death, or 4) a family history of hypertrophic cardiomyopathy deserves extensive and thorough evaluation.