Predictors of Toxicology Results in Sudden Unexpected Death Cases Released by the Medical Examiner to the Hospital
Odey C Ukpo, Louis P Dehner. Washington University, Saint Louis, MO
Background: Toxicology plays an integral role in the investigation of sudden unexpected death cases. Such cases fall into the jurisdiction of the Medical Examiner, but on occasion these cases are released to the hospital. The utility of toxicology in medical autopsy cases released by the Medical Examiner is unclear. Documentation of ante-mortem suspicious behavior indicating toxin use/exposure may be important. We hypothesize that documented suspicious behavior strongly correlates with positive lethal levels of toxins.
Design: All sudden death cases that had toxicology test performed from February 1 2012 to August 1 2012 were included. Cases were selected from a log book of toxicology request in the autopsy suite. All toxicology tests included a general screen, and confirmatory test if indicated. The medical record was reviewed for evidence of suspicious behavior, and the autopsy report for toxicology results and anatomic cause of death. Lethal toxin levels were considered positive, and non-lethal or negative results were called negative.
Results: Eleven cases were identified with a median age of 37, with the majority being female (64%). Two cases had lethal toxin levels and were determined as the immediate cause of death (18%). Both cases with lethal levels were pain medications with documented suspicious behavior of drug abuse immediately before death. The remaining 9 cases did not have documented suspicious behavior with negative toxin screens (p=0.02). In one negative case the patient had a history of heroin abuse with track marks noted on exam, but no indication of recent drug use.
Conclusions: Toxicology results in sudden death cases can provide the information needed for immediate cause of death in sudden death cases released by the Medical Examiner. Key information retrieved from a scene investigation and interview of family members or friends of the decedent is not available to a non Forensic Pathologist, necessitating other predictors for accidental overdose. A documented recent history of suspicious behavior suggesting toxin use/exposure may reliably predict a positive result. A history of drug abuse may not indicate an overdose as the cause of death.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 4, Monday Morning