A critical review of sudden unexpected deaths at Tygerberg Hospital Forensic Pathology Laboratory over a one-year period in 2016

Thesis (MMed)--Stellenbosch University, 2021.Background In South Africa, admissions of sudden and unexpected deaths to large Forensic Pathology Laboratories (FPL) for medicolegal post-mortem examination are generally on the increase. Research in this field is useful to identify disease patterns and to reduce unnecessary admissions to forensic pathology services. Objectives Our main aim was to determine the recent epidemiological profile of sudden and unexpected deaths admitted to Tygerberg FPL from 1 January to 31 December in 2016, compared to a past similar study that evaluated similar data of 2001 to 2005. A secondary objective was to ascertain the contribution of respiratory disease. Method A retrospective study was conducted. Anonymized data were obtained from post-mortem case files for analysis and comparison, using an electronic Open Data Kit application, Red Cap electronic database and Windows Excel for secure storage, and Statistical Package for Social Sciences for biostatistical analyses. Results The total number of cases that were admitted to Tygerberg FPL in 2016 for medicolegal post-mortem examination were 3766. The past epidemiological study at the same facility evaluating the data of 2001 to 2005, showed an annual average of approximately 2700 admissions. Admissions of more than 1000 above the previous annual average was thus demonstrated. Of the 3766 admissions in 2016, a sum of 770 cases comprised the study population of sudden and unexpected deaths, of which 539 (70%) were adults and 231(30%) children. All cases that were known to have an unnatural cause of death upon admission were excluded A younger average age of 34 years and continued male predominance was demonstrated in the study population. The manner of death was presumably natural in 496 (64.4%) cases, unnatural in 60 (7.8%) cases and undetermined in 214 (27.8%) cases. In the population of minors (<18 years of age), presumed natural deaths accounted for 145/231 (62.8%) cases. Diseases of the respiratory and cardiovascular systems continued to be the leading natural causes of death in the overall study population. Pneumonia was the most prevalent cause of death in the population of minors (