We compared sudden unexpected death in epilepsy (SUDEP) diagnosis rates between North American SUDEP Registry (NASR) epileptologists and original death investigators, to determine degree and causes of discordance. In 220 SUDEP cases with post‐mortem examination, we recorded the epileptologist adjudications and medical examiner‐ and coroner‐ (ME/C) listed causes of death (CODs). COD diagnosis concordance decreased with NASR’s uncertainty in the SUDEP diagnosis: highest for Definite SUDEP (84%, n = 158), lower in Definite Plus (50%, n = 36), and lowest in Possible (0%, n = 18). Rates of psychiatric comorbidity, substance abuse, and toxicology findings for drugs of abuse were all higher in discordant cases than concordant cases. Possible SUDEP cases, an understudied group, were significantly older, and had higher rates of cardiac, drug, or toxicology findings than more certain SUDEP cases. With a potentially contributing or competing COD, ME/Cs favored non–epilepsy‐related diagnoses, suggesting a bias toward listing CODs with structural or toxicological findings; SUDEP has no pathognomonic features. A history of epilepsy should always be listed on death certificates and autopsy reports. Even without an alternate COD, ME/Cs infrequently classified COD as “SUDEP.” Improved collaboration and communication between epilepsy and ME/C communities improve diagnostic accuracy, as well as bereavement and research opportunities.

中文翻译：

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SUDEP 分类：法医调查员和癫痫病学家之间的不一致

我们比较了北美 SUDEP Registry (NASR) 癫痫学家和原始死亡调查员的癫痫猝死 (SUDEP) 诊断率，以确定不一致的程度和原因。在 220 例经过尸检的 SUDEP 病例中，我们记录了癫痫专家的裁决以及法医和验尸官 (ME/C) 列出的死因 (COD)。COD 诊断一致性随 NASR 在 SUDEP 诊断中的不确定性而降低：Definite SUDEP 最高（84%，n = 158），Definite Plus 较低（50%，n = 36），而可能最低（0%，n = 18） . 精神疾病合并症、药物滥用和滥用药物的毒理学发现率在不一致的情况下都高于一致的情况。可能的 SUDEP 病例是一个研究不足的组，年龄显着更大，心脏、药物、或毒理学发现比某些 SUDEP 病例更多。由于潜在的贡献或竞争 COD，ME/Cs 倾向于非癫痫相关的诊断，这表明偏向于列出具有结构或毒理学发现的 COD；SUDEP 没有特定的特征。癫痫病史应始终列在死亡证明和尸检报告中。即使没有替代 COD，ME/C 也很少将 COD 归类为“SUDEP”。改善癫痫和 ME/C 社区之间的合作和交流，提高诊断的准确性，以及丧亲和研​​究机会。癫痫病史应始终列在死亡证明和尸检报告中。即使没有替代 COD，ME/C 也很少将 COD 归类为“SUDEP”。改善癫痫和 ME/C 社区之间的合作和交流，提高诊断的准确性，以及丧亲和研​​究机会。癫痫病史应始终列在死亡证明和尸检报告中。即使没有替代 COD，ME/C 也很少将 COD 归类为“SUDEP”。改善癫痫和 ME/C 社区之间的合作和交流，提高诊断的准确性，以及丧亲和研​​究机会。