Background: Sudden unexpected natural death (SUND) has not been studied in Iran. Herein we investigated its main causes in our country.Methods: Records of 80 cases registered to a single referral center were investigated to determine the distribution of sex, age, and etiology of death.Results: Fifty eight (72.5%), 6 (7.5%), 6 (7.5%) and 4 (5%) of our cases have died due to various types of heart diseases, cerebral events, pulmonary emboli and gastrointestinal bleeding (GIB), respectively. Moreover, men are victims of SUND more that women (83.7% vs.16.3%, respectively).Conclusion: Policies should be planned by the governments to prevent youth mortality in societies. These attempts should especially target ischemic heart disease

Behnoush, B

Fayaz, AF

Goudarzi, A

Taghaddosinejad, F

English

Journals Portal, Shahid Beheshti University of Medical Sciences

International Journal of Medical Toxicology and Forensic Medicine. 2015;5(1): 8-11.   Sudden Unexpected Natural Death in the Youth; an Iranian Single Center Investigation Fayaz AF1*, Goudarzi A2, Taghaddosinejad F3, Behnoush B3 1Department of Forensic Medicine and Toxicology, Aja University of Medical Sciences, Tehran, Iran 2Department of Forensic Medicine and Toxicology, Legal Medicine Organization, Isfahan, Iran 3Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Tehran, Iran   A R T I C L E I N F O  A B S T R A C T  Article Type: Original Article   Article History: Received: 28 Apr 2014 Revised:  10 May 2014 Accepted: 23 May 2014  Keywords: Sudden death Young adults Life style    Background: Sudden unexpected natural death (SUND) has not been studied in Iran. Herein we investigated its main causes in our country. Methods: Records of 80 cases registered to a single referral center were investigated to determine the distribution of sex, age, and etiology of death. Results: Fifty eight (72.5%), 6 (7.5%), 6 (7.5%) and 4 (5%) of our cases have died due to various types of heart diseases, cerebral events, pulmonary emboli and gastrointestinal bleeding (GIB), respectively. Moreover, men are victims of SUND more that women (83.7% vs.16.3%, respectively). Conclusion: Policies should be planned by the governments to prevent youth mortality in societies. These attempts should especially target ischemic heart disease.    Copyright©2015 Forensic Medicine and Toxicology Department.  All rights reserved. Implication for health policy/practice/research/medical education: Sudden Unexpected Natural Death in the Youth     Please cite this paper as: Fayaz AF, Goudarzi A, Taghaddosinejad F, Behnoush B. Sudden Unexpected Natural Death in the Youth; an Iranian Single Center Investigation. International Journal of Medical Toxicology and Forensic Medicine. 2015; 5(1): 8-11.   1. Introduction: The crude death rate is the total death number per 1000 people per year and is one of the critical indexes of the development in each society. Besides, according to the crucial role of young adults in countries, youth mortality is great concern (1). Therefore, determination of main factors resulting to youth mortality can be considered as one of the fundamental duties of governments.  Sudden unexpected natural death (SUND) is one of the causes of youth mortality and is defined by the world health organization (WHO) as a death in an apparently healthy young individual after 24 hours from when symptoms began. Sudden death can be attributed to a broad range of disorders and comprises sudden cardiac and non-cardiac death (2, 3).  In 1984, Sarkioja and Hirvonen studied the causes and incidence of sudden and/or unexpected death in 77 cases. They found ischemic heart disease (IHD), Corresponding author: Fayaz AF, MD. Assistant professor of Forensic Medicine and Toxicology, Aja University of Medical Sciences, Tehran, Iran E-mail: swt_f@farasa.org Sudden Unexpected Natural Death in the Youth                                                                Fayaz AF et al International Journal of Medical Toxicology and Forensic Medicine. 2015;5(1)                             9 subarachnoid hemorrhage (SAH) and alcoholism as the most frequent etiologies for unexpected sudden death (4). Additionally, Siboni and Simonsen in 1986 have performed autopsies on 78 cadavers who met the criteria of sudden unexpected natural death in the age group 2-30 years. They found a large number of cases with history of epilepsy, alcoholism, gynecologic problems and drug addiction (5).  As no such study has been conducted in Iran, we attempted to investigate the incidence and main reasons of SUND in cases referred to a single center in Iran so that further preventive plans are implemented.  2. Materials and Methods: After approval of the institutional board for ethics, from all 9936 death records registered to Kahrizak research and educational center (affiliated to Tehran University of Medical Sciences, Tehran, Iran)  and over one year (March 2008 – March 2009), the 406 cadavers with SUND were considered for the study. Cases with unnatural death causes have not been enrolled and thus, 124 cases with 15-35 years of age were found to meet the inclusion criteria. According to the below mentioned equation, however, sample size of 80 cases was determined (4, 6).  Equation 1: calculation of required sample size                 ⁄  Confidence interval (CI)=95%, P=75%, α=0.05, D=10% and z=1.96 This amount of cases was selected from the 124 match records with the use of random number table. Afterwards, file number, sex, age, and reason for death (achieved from necroscopic, pathologic, toxicological and clinical studies) was recorded and analyzed by SPSS 12 software regarding descriptive values.  3. Results: Sixty (75%) cases were within 30-35 years of age, 14 (17.5%) within 25-29, 5 (6.25%) within 20-24 and one (1.25%) was within 15-19 years of age. There were 50, 11, 5 and 1 male(s) in each age group, respectively. Ten females were in 30-35 and three were in 25-29 age groups (Table 1).  As demonstrated in table 2, 58 (72.5%) of our cases have died due to heart diseases of various types. Cerebral events, pulmonary emboli and gastrointestinal bleeding (GIB) were the main causes of death in the rest 6 (7.5%), 6 (7.5%) and 4  Table 1: Number of cases in each cause-of-death category divided to age groups age group 15-19 20-24 25-29 30-35  male female total male female total male female total male female total ICH - - - - - - - - - 38 5 43 Cardiomiopathy - - - 1 - 1 3 1 4 2 2 4 VHD - - - - - - 1 - 1 2 3 5 pulmonary emboli - - - 1 - 1 1 1 2 3 - 3 epilepsy - - - 1 - 1 1 - 1 - - - SAH - - - - - - 3 1 4 - - - GIB - - - - - - 1 - 1 3 - 3 unknown 1 - 1 2 - 2 1 - 1 2 - 2 total 1 - 1 5 - 5 11 3 14 50 10 60 IHD: ischemic heart disease; VHD: valvular heart disease; SAH: subarachnoid hemorrhage; GIB: gastrointestinal bleeding Fayaz AF et al                                                                Sudden Unexpected Natural Death in the Youth 10                                International Journal of Medical Toxicology and Forensic Medicine. 2015;5(1) (5%) of our cases. Noticeably, 6 (7.5%) persons have died due to unknown reasons.  4. Discussion: The definition of the term sudden death varies from 15 minutes, one hour, and six hours and up to 24 hours from onset of symptoms (7). In this study, however, we have considered the definition proposed by WHO defined as death up to 24 hours after initiated symptoms (4).  We necropsied 80 cadavers which had best fit the inclusion criteria of SUND in our referral center. We found ischemic heart disease (IHD), cardiomyopathies and valvular heart disease (VHD) responsible for death in 43%, 9% and 6%, respectively. This is similar to reports of other investigators who have found heart disease as the most leading cause of sudden death in the youth (8, 9). After cardiac etiologies, pulmonary emboli (6%), subarachnoid hemorrhage (SAH) (4%), gastrointestinal bleeding (GIB) (4%) and epilepsy (2%) were the top causes of death in our study population.  Additionally, cerebral causes were found in 4.3% and 16.9% of Danish and Australian cases, respectively. In the mentioned countries, pulmonary emboli were responsible for 17.7% and 21.3% of death, respectively (4-6).  In our society alcoholism is rare and therefore no such evidence have found in our cases. However, according to the stressful style of living, poor food habits as well as air pollution and smoking, heart diseases are predictable to play a significant role in occurrence of SUND within Iranian individuals.  Therefore, it is mandatory to consider effective action in preventing IHD more than just control of the classical risk factor of coronary heart disease. This is actually the duty of governments to support scientific studies and moreover develop educational and cultural programs by which life style of people are justified.  5. Acknowledgement: The authors would like to thank Farzan Institute for Research and Technology for technical assistance.  References 1. Kurth-Schai R. The roles of youth in society:  a reconceptualization. Educational Forum. 1988;52(2):131-2. 2. Swalwell CI, Reddy SK, Rao VJ. Sudden death due to unsuspected coronary vasculitis. Am J Forensic Med Pathol. 1991;12(4):306-12. 3. Kedar R, Eisen A, Dovrish Z, Hadari R, Lew S, Amital H. Isolated coronary vasculitis as a cause of unexpected sudden Table 2: Number and percentage of cases in each cause-of-death category  male female total  frequency percent frequency percent frequency percent ICH 38 56.7 5 38.6 43 53.7 cardiomiopathy 6 9 3 23 9 11.2 VHD 3 4.4 3 23 6 7.5 pulmonary emboli 5 7.5 1 7.7 6 7.5 epilepsy 2 3 0 - 2 2.6 SAH 3 4.4 1 7.7 4 5 GIB 4 6 0 - 4 5 unknown 6 9 0 - 6 7.5 total 67 100 13 100 80 100 IHD: ischemic heart disease; VHD: valvular heart disease; SAH: subarachnoid hemorrhage; GIB: gastrointestinal bleeding Sudden Unexpected Natural Death in the Youth                                                                Fayaz AF et al International Journal of Medical Toxicology and Forensic Medicine. 2015;5(1)                             11 death. Isr Med Assoc J. 2009;11(12):769-70. 4. Sarkioja T, Hirvonen J. Causes of sudden unexpected deaths in young and middle-aged persons. Forensic Sci Int. 1984;24(4):247-61. 5. Siboni A, Simonsen J. Sudden unexpected natural death in young persons. Forensic Sci Int. 1986;31(3):159-66. 6. Schwartz PJ, Stramba-Badiale M, Segantini A, Austoni P, Bosi G, Giorgetti R, et al. Prolongation of the QT interval and the sudden infant death syndrome. N Engl J Med. 1998;338:1709-14. 7. Luke JL, Helpern M. Sudden unexpected death from natural causes in young adults. A review of 275 consecutive autopsied cases. Arch Pathol. 1968;85(1):10-7. 8. Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep. 2008;56(10):1-120. 9. Vaartjes I, Hendrix A, Hertogh EM. Sudden death in persons younger than 40 years of age: incidence and causes. Eur J Cardiovasc Prev Rehabil. 2009;16(5):592-596.  

Sudden Unexpected Natural Death in the Youth; an Iranian Single Center Investigation

https://journals.sbmu.ac.ir/ijmtfm/article/download/IJMTFM-6341/pdf_38

Sudden Unexpected Natural Death in the Youth; an Iranian Single Center Investigation

Abstract

Similar works

Full text

Available Versions

Journals Portal, Shahid Beheshti University of Medical Sciences