Profile of Sudden Death in an Irish Adult Population (1999-2008)
MR Downes, J Thorne, HA Hassan, TN Tengku Khalid, M Leader. Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons, Dublin, Ireland
Background: Sudden death is the sudden and unexpected death of a person within 24 hours of symptom onset. The majority of these cases are cardiac in origin. We analysed over 1000 autopsy cases performed over one decade (1999-2008) to identify and subclassify the causes of death in an Irish adult population within the catchment area of a university affiliated, tertiary referral hospital. The autopsies all fell under the remit of the Coronial service.
Design: A retrospective audit was conducted on all autopsies performed over a ten year period to identify those ascribed as sudden deaths. All adult patients (16 years of age or older) found dead and brought to the hospital who had been seen alive in the prior 24 hours and those that died within 24 hours of admission to the Accident and Emergency department were include. Autopsy log books, computer records and Coroners Authorisation forms were utilised to identify our cohort. The results were analysed according to age and organ system involved.
Results: A total of 2,809 post mortems were performed in the defined review period, 1,230 of which were within the study parameters. The majority of subjects were over forty (86%, n= 1,057) and overall males outnumbered females in a 2:1 ratio. In 2.8% of cases (n= 35) a definitive cause of death was not found. Cardiovascular deaths dominated in the over forties. Overall 63% (n= 775) of all sudden deaths were ascribed to a cardiovascular cause (two thirds of which were myocardial infarction/severe coronary artery disease). Death due to a respiratory cause was the second commonest listed cause of death at 13% (n=158). Accidental death was the third commonest cause of death (11%, n= 138) and the commonest in the under forties.
Conclusions: The results from our cohort demonstrate that the vast majority of sudden adult death is cardiac in nature, mainly due to underlying coronary artery disease. This autopsy series of over 1,000 cases successfully identified a cause of death in 97.2% (n= 1,195) of cases. This is the first Irish study to examine all sudden deaths in an adult population and subclassify these according to age and organ system. Nine cases of the under 40's age group had an unidentifiable cause of death. The recent literature regarding sudden cardiac death in the structurally (and microscopically) normal heart raise the possibility of a potential genetic aetiology having been overlooked. This highlights the value of such retrospective audits in informing future clinical practice.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 3, Wednesday Morning