Investigation of Sudden Death in Athletes: The Fittest Bodies in the Morgue

Sporting events are generally viewed as regulated activities with fit and healthy participants; therefore, when deaths occur, they draw considerable public interest. Athletic participants can be considered a vulnerable population based on inherent risks within certain sports and the associated physiologic stresses, which may complicate underlying medical conditions. Sudden deaths in young athletes participating in high school and collegiate organized sports occur at an average of four to six deaths per year; however, sudden deaths related to exercise outside of an organized sport setting remain unaccounted for in the overall prevalence of these deaths. A typical forensic pathology practice will see not only these higher-profile deaths occurring during an organized sporting event, but also lower-profile occurrences of individuals dying during more recreational or unstructured exercise. Sport-related deaths can essentially be categorized as those that occur due to dangers inherent in the sport itself, such as forms of heat-related illnesses, blunt force trauma, and water-related deaths, and those that occur due to susceptibilities of a given predisposed participant, including sickle cell trait, hypertrophic cardiomyopathy, and other cardiovascular diseases. This article will address both types of vulnerabilities and provide guidance for appropriate and specific medicolegal death investigation and autopsy procedures in these deaths.