Sudden and unexpected deaths in adults : an investigation of cases reported to Tygerberg Forensic Pathology Services from January 2001 - December 2005

Tiemensma, Marianne (Stellenbosch : University of Stellenbosch, 2010-12)

Thesis

ENGLISH ABSTRACT: Background - The workload of the forensic pathologist and Forensic Pathology Services staff is increased by the referral of potentially unnecessary natural cases to the Forensic Pathology Services. The primary aims of the medico-legal autopsy are limited to establishing a cause of death in presumed unnatural cases, and to exclude criminality or negligence. Objective – To determine the final outcomes of forensic post-mortem examinations in “sudden and unexpected” adult deaths over a 5 year period. Methods - An observational, retrospective, descriptive study was conducted. ”Sudden and unexpected” adult deaths referred to Tygerberg Forensic Pathology Services between 1 January 2001 and 31 December 2005 were reviewed. Data was collected from the autopsy reports, contemporaneous notes and hospital records. Findings – A total of 816 adult cases of sudden and unexpected death were referred to Tygerberg Forensic Pathology Services over the 5 year period studied. Complete autopsies had been performed in 74% (601/816) of cases. The presumed manner of death was natural in 79 % of cases, and an increase in the number of natural cases autopsied per year was noted over the 5-year study period. Diseases of the cardiovascular, respiratory and central nervous systems were responsible for the majority of natural deaths. Infectious diseases were responsible for most deaths in the youngest age group studied (18-29 years). Acute alcohol poisoning was responsible for the deaths of 35 (6%) cases, with an average blood alcohol concentration of 0.38g/100mL in these cases. Eight deaths were drug-/substance related. Waiting times for blood alcohol and toxicology results increased over the 5-year study period. No cause of death was found in 10.6% of cases. Conclusions -The questionnaire and interviewing structure could possibly be improved in order to obtain better pre-autopsy information and to reduce the number of “unnecessary” medicolegal autopsies, thereby reducing the burden of cost on the Forensic Pathology Services.

AFRIKAANSE OPSOMMING: Agtergrond – Die werkslading van die forensiese patoloog en ander personeel van die Forensiese Patologie Dienste word vermeerder deur die verwysing van moontlik onnodige natuurlike gevalle na die Forensiese Patologie Dienste. Die primêre doelwitte van die medies-geregtelike nadoodse ondersoek is beperk tot die bepaling van ‘n oorsaak van dood in vermoedelik onnatuurlike gevalle, en om nalatigheid of kriminele aksies uit te skakel. Doelwit – Om die finale uitkomste van medies-geregtelike nadoodse ondersoeke in “skielike en onverwagte” volwasse sterftes oor ‘n 5-jaar tydperk te bepaal. Metodes – ‘n Observasionele, retrospektiewe, beskrywende studie is uitgevoer. “Skielike en onverwagte” volwasse sterftes wat verwys is na Tygerberg Forensiese Patologie Dienste vanaf 1 Januarie 2001 tot 31 Desember 2005 is hersien. Inligting is versamel vanaf die nadoodse ondersoekverslae, kontemporêre notas en hospitaalnotas. Bevindinge – Agthonderd en sestien volwasse gevalle van skielike en onverwagte sterftes is oor die 5-jaar periode verwys na Tygerberg Forensiese Patologie Dienste. Volledige lykskouings is uitgevoer in 74% (601/816) van die gevalle. Die vermoedelike wyse van die sterfte was natuurlik in 79.04% en ‘n toename in die aantal natuurlike gevalle wat lykskouings ondergaan het, is waargeneem oor die 5-jaar studie tydperk. Siektes van die kardiovaskulêre, respiratoriese en sentrale senuweestelsel was verantwoordelik vir die meerderheid natuurlike sterftes. Infektiewe toestande was verantwoordelik vir die meeste sterftes in die jongste ouderdomsgroep (18-29 jaar) wat bestudeer is. Akute alkoholvergiftiging was verantwoordelik vir die sterftes van 35 (6%) gevalle, met ‘n gemiddelde bloed-alkohol-konsentrasie van 0.38g/100mL in hierdie gevalle. Agt sterftes was dwelm-/middelverwant. Die wagtyd vir bloed-alkohol en toksikologie resultate het vermeerder oof die 5-jaar studie tydperk. Die oorsaak van dood was nie gevind in 10.6% van gevalle. Afleidings – Die vraelys en onderhoud-struktuur kan moontlik verbeter word om sodoende beter inligting te verkry voor die uitvoering van ‘n lykskouing, en om die aantal “onnodige” medies-geregtelike nadoodse ondersoeke te verminder, en sodoende die kostedruk te verminder op die Forensiese Patologie Dienste.

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