Performing autopsies of all sudden deaths: a public health prevention strategy

Introduction: In France, the management of sudden death (including non-forensic autopsies) among adults could be improved. The number of sudden deaths may require a change in practice to promote screening for hereditary diseases. The purpose of this study was to identify areas for improvement and to assess the prevalence of non-forensic autopsies. Methods: A retrospective study (2005-2010) conducted at Lille University Hospital resulted in the selection of 174 non-forensic autopsies of adults who died suddenly. The criteria used were: the geographical origin of the bodies, indication, age, gender and the diagnosis of death. Results: The study found that the annual number of non-forensic autopsies was very low, with proportions ranging from 1.06 to 1.73 per 1,000 deaths in the case of hospital deaths and from 0 to 0.43 per 1,000 deaths in the case of non-hospital deaths. Only 11 non-forensic autopsies of people who died at home were recorded over the study period, including 4 heart disease-related deaths. Overall, the results indicate that sudden death autopsies are poorly managed. Discussion: Non-forensic autopsies are in decline, particularly in the case of deaths outside hospital, despite the fact that they are a crucial consideration for screening among relatives of a person who died suddenly. The findings suggest that there needs to be an improvement in practice, a fact made possible by recent legislative developments in France. A number of initiatives have been successful and give hope that, like the reference centers specializing in unexpected infant deaths, reference centers specializing in sudden deaths, which allow for more systematic non-forensic autopsies of adults who die suddenly, might be created.