A 10-year retrospective analysis of sudden unexpected death in the young investigated at Salt River Mortuary, Cape Town

Sudden unexpected death in the young (SUDY) is defined as the rapid, unsuspected demise of an apparently healthy individual between the ages of one and 40 years. There is a gap in research pertaining to this population in a South African context. This retrospective study aimed to explore the burden, scope of post-mortem investigation, and risk factors of SUDY admissions to Salt River Mortuary (SRM) in Cape Town between 1 January 2010 and 31 December 2019. Medico-legal case files pertaining to SUDY cases from SRM were reviewed. SRM received a total of 34 601 admissions in the 10-year period; of which 1 997 (5.77%) were SUDY cases. Nearly two-thirds (62.59%) of the SUDY admissions were male. The leading cause of death was pneumonia (17.11%), and the most prevalent organ system implicated in cause of death was the pulmonary system (45.19%). At least 32.46% of SUDY cases were infectious-related, with varying degrees of confidence. A large proportion of cases had no history of acute or chronic illness (45.43%), and no family history of illness (56.66%). In total, 52 potential candidates were identified for a molecular autopsy, of which 47 have stored biological samples for future investigations. This study advocates for the routine performance of post-mortem ancillary microbiological and toxicological testing in cases of SUD, considering the large burden of infectious disease and substance abuse in South Africa. The retention of biological samples in undetermined or non-specific natural cases is also urged, to allow for cause of death determination on a molecular level.