Unveiling the unpredictable: A comprehensive inquiry into sudden and unexpected deaths undergoing medico-legal investigation at Tygerberg Forensic Pathology Services Mortuary

Sudden and unexpected death (SUD) is the abrupt death of a seemingly healthy individual, which requires medico-legal investigation under the South African Inquest Act (1959) and the National Health Act (2003). Studies conducted in South Africa from 2001 to 2016 report a SUD prevalence between 4% and 14%; however, research is limited. This study aimed to review SUD in adults at Tygerberg Forensic Pathology Services Mortuary (TFPSM) to determine the prevalence, leading causes, and demographic and temporal patterns. This was a retrospective descriptive study employing non-probability convenience sampling. The study included all cases of SUD in adults admitted for medico-legal death investigation to the TFPSM in Cape Town between 2021 and 2022. This study determined the prevalence of SUD in adults, identified the leading causes of death, and profiled the demographics and temporal characteristics. Cases of SUD in adults comprised 9.3% of all deaths admitted to TFPSM, with cardiovascular disease (34%) being the leading cause, followed by respiratory-related causes (26.6%) and HIV/TB (8.5%). Males accounted for 70.9% of cases, and deaths were most common in the 51-60 age group. Khayelitsha and Bellville were identified as locations with the highest number of deaths. Alcohol and toxicology results showed an association with cardiovascular disease. The study highlights the high number of cardiovascular disease deaths, along with respiratory, and infectious diseases. Improving healthcare access, implementing screening programs, and establishing medical histories are key to reducing SUD cases in the future. • Sudden and unexpected deaths accounted for 9.3% of cases between 2021-2022. • Cardiovascular disease was found to be the leading cause of death (34%). • Males represented 70.9% of cases, with the majority of deaths in the 51-60 age group. • Khayelitsha and Bellville accounted for the highest number of deaths. • Highlights the need for better healthcare access, screening programs, & medical history.