Sudden Unexplained, Non-Traumatic Death in ≤35 Year Olds: An Irish Coroner's Autopsy Population Based Study
A Chelliah, K O'Connor, SC Chak, L Burke, M Bolster. Cork University Hospital, Cork, Ireland; Cork City Morgue, Cork, Ireland
Background: The prevalence and cause of sudden unexplained, non-traumatic death varies with age and is most prevalent from 0-6months and 45-75years due to Sudden Infant Death Syndrome(SIDS) and Coronary Artery Disease(CAD) respectively. It is less well categorized in the younger adult population. The aim of this study was to evaluate the incidence and categorize the causes of sudden unexplained, non-traumatic death in ≤35year olds within an Irish Coroner's autopsy population, with particular interest in cardiac causes and Sudden Adult Death Syndrome(SADS).
Design: Retrospective analysis of autopsies performed on ≤35year olds in the Cork / Kerry region from July 2001 to June 2009. The ≤35year old regional population is approximately 324,000. Autopsy reports were reviewed for circumstances of death, histology, toxicology, microbiology and cause of death. All traumatic and suicide deaths were excluded.
Results: 252 (164 males; 88 females) cases met the study criteria with the following age distribution: 0-1year = 52; >1-17years = 37; 18-35years = 163. 47(18.7%) deaths had a cardiac cause including CAD, hypertrophy, cardiomyopathy, arrhythmia, myocarditis, Congenital Heart Disease(CHD), tamponade and fibroma. 11(4.4%) cases were SADS. 164(65.1%) deaths were drug/alcohol related, 34(13.5%) had CNS causes, 27(10.7%) respiratory causes and 6(2.4%) GI causes. 35(13.9%) deaths were SIDS with 9(25.7%) documented co-sleepers. Remaining deaths were due to diabetes mellitus, sickle cell disease, connective tissue disease, hypersensitivity and stillbirth. Cause was unascertained in 8(3.2%) cases.
Conclusions: The incidence of sudden unexplained, non-traumatic death in this population was 0.08%. Deaths occurred mainly in males(65.1%) in the 18-35 age group (median age 26.8) and were alcohol, cocaine or heroin related. A notable increase in heroin use was seen in the last two years. Cardiac deaths were most frequent in males in the 18-35 age group (median age 32.2) with CAD(27.7%) leading. CHD was the main cardiac cause in 0-1year olds although overall SIDS was the leading cause of death in this group. In the >1-17age group CNS causes were commonest. Interestingly, dual cause of death was identified in 5(1.9%) cases where CAD, myocardial infarction, myocarditis(x2) and intracerebral haemorrhge(ICH) were associated with toxic levels of drugs/alcohol. SADS incidence was similar to prior studies at 4.3% (median age 27.4) but as distinct to documented figures the male to female ratio was 0.57:1.
Monday, March 22, 2010 1:30 PM
Platform Session: Section G, Monday Afternoon