A Retrospective Forensic Review of Sudden Unexpected Infectious Deaths in Ontario
CCCF ePoster library. Sehgal P. Nov 8, 2018; 233337
Dr. Prateek Sehgal
Dr. Prateek Sehgal
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Abstract
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Introduction

The phenomenon of sudden and unexpected death has largely been characterized for primary cardiac or respiratory death. There remains a subset of the population that decline abruptly and unexpectedly primarily due to infectious pathogens. This has resulted in a knowledge gap in identifying the spectrum of pathogens and clinical syndromes which may lead to fulminant decline and death potentially even before exposure to a healthcare setting.

 

Objectives

The aim of this study was to better characterize and understand patient, pathogen, and disease-related factors in the phenomenon of sudden, unexpected infectious deaths.

 

Methods

We carried out a population-based, retrospective cohort study of all community sudden infectious deaths in Ontario, Canada between January 1, 2016 to December 31, 2017. Autopsy records were extracted from the Ontario Forensics Pathology Service (OFPS) which encompassed a catchment population of 14 million within the provinces of Ontario and northeastern Manitoba in Canada. We collected patient-related information, infection-related information, and circumstances around death for each case to carry out descriptive analyses.

 

Results

Of the 7506 cases of sudden or unexpected death over the 2-year study period, we identified 418 cases (6%) related to infectious diseases. Patients with sudden infectious deaths had similar age distribution in comparison to patients with sudden deaths from other causes [median age (IQR) age of 55 (45 – 64) vs. 54 (41 – 64), p = 0.27] while having a less pronounced male gender predominance (60% males vs. 68% males, p = 0.001). Bacterial pneumonia (43%) was the most common infectious cause of sudden death population-wide followed by septic shock (12%), peritonitis (10%), myocarditis (6%), and pyelonephritis/abscess (5% each). A causative pathogen was isolated in 210 cases (50%) with Staphylococcus aureus (N = 35) being the most commonly cultured organism, followed by Streptococcus pneumoniae (N = 30), Streptococcus pyogenes (N = 25), Klebsiella pneumoniae (N = 21), and Escherichia coli (N = 19). The majority of deaths were pronounced at the patient's residence (63%) while a minority were pronounced in the Emergency Department (18%) and shortly after hospital admission (19%). 68% of patients exhibited prodromal symptoms prior to death with a median (IQR) length of 1.0 (0.0-4.0) days and 30% of patients had recent healthcare contact prior to their demise.

 

Conclusion

Infectious diseases have the potential to cause rapid and fulminant clinical decline. The most common etiology of sudden infectious death within our population was bacterial pneumonia and, predominantly, gram positive bacteria. Our study highlights potential opportunities for intervention given a number of patients had recent healthcare contact prior to their death and the most frequent cause of death was via common community infections and pathogens. However, given the rapidity of disease progression, prevention will require upstream strategies to prevent infection transmission such as through further vaccine development.

 


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