Fatal hyperthermia and heatstroke in children and adults: a ten-year retrospective autopsy-based analysis.

Hyperthermia is a preventable cause of death that lacks a specific postmortem finding, and its diagnosis relies on scene and environmental information and on the exclusion of alternative causes. We characterized the demographic, environmental, and pathological features of hyperthermia deaths over a ten-year period at a national forensic reference board and compared pediatric and adult patterns descriptively. Twenty-two cases certified as hyperthermia or heatstroke between 2015 and 2024 were reviewed retrospectively; investigation files, scene and meteorological records, clinical documents, autopsy and histopathology reports, and toxicology results were evaluated together, and cases were grouped as pediatric (<18 years) or adult (≥18 years). Twelve cases were children and 10 were adults; 15 (68.2%) were male. Eleven children (91.7%) died inside parked vehicles, whereas adult deaths mostly occurred outdoors, in occupational settings, and under exertion. The maximum ambient temperature on the event day was ≥35 °C in 16 cases (72.7%; cohort median 37.0 °C). Nineteen cases (86.4%) had no antemortem medical contact. Cerebral congestion and pulmonary edema were common but non-specific, and chronic cardiac pathology was found only in adults. In this series, scene and exposure patterns differed between pediatric and adult cases-vehicular entrapment in children and exertional or occupational heat exposure in adults. Because no postmortem finding is specific, the forensic diagnosis should rest on the joint evaluation of scene and meteorological data with autopsy, histopathological, and toxicological findings and on the exclusion of alternative causes, and prevention should be tailored to age and exposure context.