Issues in the interpretation of postmortem toxicology

Byard, Roger W.; Butzbach, Danielle M.

doi:10.1007/s12024-011-9278-x

Cited by 30 publications

(21 citation statements)

References 15 publications

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“…In the other case analysed (case 5), whilst there is a natural cause of death reported, the significance of the toxicological results has not been reported in the cause of death. This has been previously reported in cases where the death has been assigned to an underlying pathological condition, notably cardiovascular disease, yet the toxicological examination reveals significant drug concentrations 21 and this case does seem to support this notion. It is proposed that the use of a Bayesian network may reduce the incidence of such cases and improve the confidence in the death certification process, whilst improving the robustness of mortality statistics.…”

Section: Discussionsupporting

confidence: 73%

“…Of further note is the disparity on how a death is recorded in cases in different coronial jurisdictions 18 . A review of coronial services suggested a failure to identify deaths where drugs were deemed to have contributed 19 , yet it does not address how to resolve the issue associated with drug related deaths where drug testing is not always routinely carried out 20,21 . The Shipman Inquiry in 2003 proposed changes to the process of death certification but also noted that greater use of toxicological analyses should be adopted in the death investigation process 22 .…”

Section: Introductionmentioning

confidence: 99%

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Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality

Langford

Bolton

Carlin

et al. 2015

Journal of Forensic and Legal Medicine

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Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University's research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. Full items must not be sold commercially in any format or medium without formal permission of the copyright holder. The full policy is available online: http://nrl.northumbria.ac.uk/policies.html This document may differ from the final, published version of the research and has been made available online in accordance with publisher policies. To read and/or cite from the published version of the research, please visit the publisher's website (a subscription may be required.) Post-mortem Highlights• Systematic toxicological analysis should be routinely in death investigation.• Alternative approaches to using existing toxicological data should be considered.• Bayesian networks could be used in cases where drugs/drug combination are observed.• Influence of post-mortem redistribution requires further investigation. AbstractThe challenge of interpreting post-mortem drug concentrations is well documented and relies on appropriate sample collection, knowledge of case circumstances as well as reference to published tables of data, whilst taking into account the known issues of postmortem drug redistribution and tolerance. Existing published data has evolved from simple data tables to those now including sample origin and single to poly drug use, but additional information tends to be specific to those reported in individual case studies. We have developed a Bayesian network framework to assign a likelihood of fatality based on the contribution of drug concentrations whilst taking into account the pathological findings. This expert system has been tested against casework within the coronial jurisdiction of Sunderland, UK. We demonstrate in this pilot study that the Bayesian network can be used to proffer a degree of confidence in how deaths may be reported in cases when drugs are implicated. It has also highlighted the potential for deaths to be reported according to the pathological states at post-mortem when drugs have a significant contribution that may have an impact on mortality statistics. The Bayesian network could be used as complementary approach to assist in the interpretation of post-mortem drug concentrations.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality

Langford

Bolton

Carlin

et al. 2015

Journal of Forensic and Legal Medicine

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“…Although subjected to an intense debate, it has been hypothesized that during decomposition some microorganisms are responsible for the degradation of drugs (e.g., antidepressants, antipsychotics, benzodiazepines, cannabinoids, cocaine, heroin and morphine glucuronides) or poisons (e.g., cyanide) and for the neoformation of other metabolites (e.g., alcohol, methamphetamines and amphetamines, 4-hydroxybutanoic acid, methadone and other potent opioids) (Byard and Butzbach 2012;Gerostamoulos et al 2012;Han et al 2012). Therefore, postmortem microbial activity can, at least theoretically, interfere with autopsy findings concerning pre-mortem drug consumption and, consequently, alter the interpretation of the cause of death (Butzbach 2010;Butzbach et al 2013;Castle et al 2017;Drummer 2004;Gunn and Pitt 2012;Sastre et al 2017;Skopp 2010).…”

Section: Toxicologymentioning

confidence: 99%

Microbial forensics: new breakthroughs and future prospects

Oliveira

Amorim

2018

Appl Microbiol Biotechnol

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Recent advances in genetic data generation, through massive parallel sequencing (MPS), storage and analysis have fostered significant progresses in microbial forensics (or forensic microbiology). Initial applications in circumstances of biocrime, bioterrorism and epidemiology are now accompanied by the prospect of using microorganisms (i) as ancillary evidence in criminal cases; (ii) to clarify causes of death (e.g., drownings, toxicology, hospital-acquired infections, sudden infant death and shaken baby syndromes); (iii) to assist human identification (skin, hair and body fluid microbiomes); (iv) for geolocation (soil microbiome); and (v) to estimate postmortem interval (thanatomicrobiome and epinecrotic microbial community). When compared with classical microbiological methods, MPS offers a diverse range of advantages and alternative possibilities. However, prior to its implementation in the forensic context, critical efforts concerning the elaboration of standards and guidelines consolidated by the creation of robust and comprehensive reference databases must be undertaken.

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“…Particularly with instances of chronically used (methadone) and abused (heroin) substances, tolerance and other variables produce a wide range of drug concentrations that often overlap in the living and the dead [20]. Postmortem redistribution and the postmortem interval also may affect these concentrations [21][22][23][24][25]. Postmortem redistribution is the change that occurs in drug concentrations after death with the redistribution of drugs, for example, into the blood from the lungs, liver, or myocardium.…”

Section: Death Certificationmentioning

confidence: 99%

From Death to Death Certificate: What do the Dead say?

Gill

2016

J. Med. Toxicol.

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This is an overview of medicolegal death investigation and death certification. Postmortem toxicological analysis, particularly for ethanol and drugs of abuse, plays a large role in the forensic investigation of natural and unnatural deaths. Postmortem drug concentrations must be interpreted in light of the autopsy findings and circumstances. Interpretations of drug and ethanol concentrations are important for death certification, but they also may be important for other stakeholders such as police, attorneys, public health practitioners, and the next-of-kin.

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Issues in the interpretation of postmortem toxicology

Cited by 30 publications

References 15 publications

Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality

Post-mortem toxicology: A pilot study to evaluate the use of a Bayesian network to assess the likelihood of fatality

Microbial forensics: new breakthroughs and future prospects

From Death to Death Certificate: What do the Dead say?

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