Skip to main content

Advertisement

Log in

Evaluation of autopsy and police reports in the investigation of sudden unexplained death in the young

  • Original Article
  • Published:
Forensic Science, Medicine, and Pathology Aims and scope Submit manuscript

Abstract

To evaluate police and autopsy reports in sudden unexplained deaths in 0–40 year olds. A structured, blind review of police and autopsy reports send to a cardiac genetic service from before (February 2006–December 2007) and after (January–December 2009) new best practice guidelines were introduced in Australia and New Zealand was performed. The reviews focused on reporting on: (1) presentation and clinical history, (2) cardiac autopsy, (3) histological tests and toxicology, and (4) detailed examination of coronary arteries. 110 reports were evaluated against the guidelines. 100 % reported location, 95 % activity at time of death, and 84 % some clinical history. Less than 25 % reported on family history, presence/absence of illicit drugs or alcohol, recorded a possible arrhythmic trigger, or history of fits/faints or collapses. Over 95 % listed heart weight, valvular examinations, pulmonary and some myocardial histology. Less than 50 % commented on septal, LV (left ventricle) and RV (right ventricle) wall thickness. Less than 50 % mentioned site of histology samples, or gave specific description of LV or RV histology or conduction system. Toxicology was not mentioned in a third. Histology of coronary arteries was described in only 18 %. Post guidelines reporting increased in some areas, e.g. in 1–40 year olds: antecedent symptoms (22–61 %), number and location of histology samples (0–47 %), and histology of coronary arteries (6–50 %). Most police and autopsy reports fall short of best practice guidelines. They have improved somewhat after the new guidelines were introduced, but need to be more consistent and particularly need to include significant negative findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust. 2004;180(3):110–2.

    PubMed  Google Scholar 

  2. Puranik R, Chow CK, Duflou JA, Kilborn MJ, McGuire MA. Sudden death in the young. Heart Rhythm. 2005;2(12):1277–82.

    Article  PubMed  Google Scholar 

  3. Fragkouli K, Vougiouklakis T. Sudden cardiac death: an 11-year postmortem analysis in the region of Epirus, Greece. Pathol Res Pract. 2010;206(10):690–4.

    Article  PubMed  Google Scholar 

  4. Tester DJ, Ackerman MJ. Postmortem long QT syndrome genetic testing for sudden unexplained death in the young. J Am Coll Cardiol. 2007;49(2):240–6.

    Article  PubMed  Google Scholar 

  5. Tan HL, Hofman N, van Langen IM, van der Wal AC, Wilde AA. Sudden unexplained death: heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation. 2005;112(2):207–13.

    Article  PubMed  Google Scholar 

  6. Behr ER, Dalageorgou C, Christiansen M, Syrris P, Hughes S, Tome Esteban MT, et al. Sudden arrhythmic death syndrome: familial evaluation identifies inheritable heart disease in the majority of families. Eur Heart J. 2008;29(13):1670–80.

    Article  PubMed  Google Scholar 

  7. Skinner JR, Crawford J, Smith W, Aitken A, Heaven D, Evans CA, et al. Prospective, population-based long QT molecular autopsy study of postmortem negative sudden death in 1 to 40 year olds. Heart Rhythm. 2011;8(3):412–9.

    Article  PubMed  Google Scholar 

  8. Arnestad M, Crotti L, Rognum TO, Insolia R, Pedrazzini M, Ferrandi C, et al. Prevalence of long-QT syndrome gene variants in sudden infant death syndrome. Circulation. 2007;115(3):361–7.

    Article  PubMed  Google Scholar 

  9. Skinner JR. Sudden unexplained death in infancy and long QT syndrome. Curr Pediatr Rev. 2010;6:48–55.

    Article  Google Scholar 

  10. Gladding PA, Evans CA, Crawford J, Chung SK, Vaughan A, Webster D, et al. Posthumous diagnosis of long QT syndrome from neonatal screening cards. Heart Rhythm. 2010;7:481.

    Article  PubMed  CAS  Google Scholar 

  11. Skinner JR. Guidelines for the diagnosis and management of familial long QT syndrome. Heart Lung Circ. 2007;16(1):22–4.

    Article  PubMed  Google Scholar 

  12. Ingles J, Semsarian C. Sudden cardiac death in the young: a clinical genetic approach. Intern Med J. 2007;37(1):32–7.

    Article  PubMed  CAS  Google Scholar 

  13. Michaud K, Fellmann F, Abriel H, Beckmann JS, Mangin P, Elger BS. Molecular autopsy in sudden cardiac death and its implication for families: discussion of the practical, legal and ethical aspects of the multidisciplinary collaboration. Swiss Med Wkly. 2009;139(49–50):712–8.

    PubMed  Google Scholar 

  14. TRAGADY. Post-mortem in sudden unexpected death in the young: Guidelines on autopsy practise. 2007. http://www.cidg.org/webcontent/LinkClick.aspx?fileticket=DO9YIQWqegI%3d&tabid=161.

  15. Skinner JR, Duflou JA, Semsarian C. Reducing sudden death in young people in Australia and New Zealand: the TRAGADY initiative. Med J Aust. 2008;189(10):539–40.

    PubMed  Google Scholar 

  16. RCPath (2005) Guidelines on autopsy practice. Scenario 1: sudden death with a likely cardiac pathology. pp. 1–7. http://wwwrcpathorg/resources/pdf/AutopsyScenario1Jan05pdf.

  17. Basso C, Corrado D, Thiene G. Cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev. 1999;7(3):127–35.

    Article  PubMed  CAS  Google Scholar 

  18. Corrado D, Basso C, Thiene G, McKenna WJ, Davies MJ, Fontaliran F, et al. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol. 1997;30(6):1512–20.

    Article  PubMed  CAS  Google Scholar 

  19. UKCPN. The UK cardiac pathology network. http://wwwukcpnorguk/database/databasehtml Accessed 5 July 2011.

Download references

Acknowledgments

We gratefully acknowledge the generous and ongoing support of Cure Kids in funding CIDG. We thank the Chief coroner (New Zealand), Judge Neil McLean for supporting the development of cardiac genetic investigation in these cases, and for allowing this audit to be conducted.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan R. Skinner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilms, H.R., Midgley, D.J., Morrow, P. et al. Evaluation of autopsy and police reports in the investigation of sudden unexplained death in the young. Forensic Sci Med Pathol 8, 380–389 (2012). https://doi.org/10.1007/s12024-012-9340-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-012-9340-3

Keywords

Navigation