Introduction: Following a retrospective study in 2022 on the management of sudden death in young individuals at the Toulouse Forensic Institute, a protocol was implemented in collaboration with the Prosecution Authority, the cardiology-electrophysiology department of the University Hospital and the medicolegal unit. This protocol aims to improve diagnosis of deaths caused by inherited heart diseases and to enhance the identification and care of at-risk relatives. This study examines the practices at the Toulouse Forensic Institute three years following the implementation of the protocol and then reports the findings of the analyses performed.

Material and method: We reviewed medicolegal records for all sudden deaths occurring in individuals aged 10 to 45 years between 2022 and 2025. Details of autopsies and toxicological, histological and genetic investigations were extracted and compared with findings from the 2022 study.

Results: The 59-individuals cohort was comparable to that of the 2022 study. Toxicological and histological samples were collected in over 90% of autopsies. However, half of them were either not analyzed or were discarded. Genetic samples were collected in 71% of cases, representing a significant improvement, although only 36% underwent analysis. Among those analyzed, all results were negative or of uncertain significance.

Discussion: This protocol has enabled us to improve our practices, yet inconsistent use of collected samples continues to limit their direct contribution to the care of relatives. This study highlights the challenges forensic medicine faces in fulfilling its public health role and underscore the need for better communication between legal and medical stakeholders.