Medical examiner and medical toxicologist agreement on cause of death

Abstract

Poisoning is a significant public health threat as the second leading cause of injury-related death in the US. Disagreements on cause of death determination may have widespread implications across several realms of public health including policy and prevention efforts, interpretation of the poisoning literature, epidemiologic data analysis, medical-legal case outcomes, and individualized autopsy interpretation. We aimed to test agreement between the cause of death determined by the medical examiner (ME) and a medical toxicologist (MT) adjudication panel (MTAP) in cases of poisoning. This retrospective 7-year study evaluated all deaths attributed to poisoning in one large urban catchment area. Cross-matched data were obtained from Department of Vital Statistics and the Poison Control Center (PCC). Out of >380,000 deaths in the catchment area over the study period, there were 7050 poisonings in the Vital Statistics database and 414 deaths reported to PCC. Cross-matching yielded 321 cases for analysis. The ME and MTAP concurred on cause of death in 66%, which was only fair agreement (κ 0.25, CI 0.14–0.38). Factors associated with the likelihood of agreement were peri-mortem fire exposures, prehospital cardiac arrest, and timing of drug toxicity (chronic versus acute). In conclusion, agreement for poisoning cause of death between specialties was much lower than expected. We recommend an improved formal process of information sharing and consultation between specialties to assure that all existing information is analyzed thoroughly to enhance cause of death certainty.

Increasing deaths involving oxycodone, Victoria, Australia, 2000–09

“…Determining a cause of death, particularly in cases of drug toxicity, is sometimes difficult 30. The 19 cases where drugs were considered to have been contributory to deaths attributed to natural disease were not included in further analysis, meaning that our results may underestimate this problem of drug deaths involving oxycodone.…”

“…In other instances the pathologist did not mention the contribution of drugs to the cause of death, despite the presence of potentially lethal levels reported in toxicology results. Discordance in opinion between forensic toxicologists and pathologists in establishing a cause of death in cases involving poisoning has been reported in the USA 30. The panel therefore included representation from a range of forensic specialisations including a pathologist, toxicologist, epidemiologist, and public health physician.…”

Analysis and Validation of Putative Substances Involved in Fatal Poisonings

“…The implications of discordance may also affect the way in which medical examiners determine poisoning as the cause of death, placing more emphasis on analysis of the clinical course of the patient. It has been reported that medical examiners and medical toxicologists may disagree on as many as 34% of cases in which poisoning was suspected as the cause of death [8]. It has also been suggested that collaboration between the RPCC and the medical examiners office may enhance the accuracy of identifying poisoning related fatalities, presumably by providing a more in-depth analysis of the clinical course of the patient [9].…”

Fatal Intoxications in the North of Portugal: 12 Years of Retrospective Analysis

“…Intoxications represent a significant public health threat [1]. In the United States of America, intoxications appear as the second leading cause of injury-related death, only surpassed by motor vehicle collisions [2].…”

“…In the United States of America, intoxications appear as the second leading cause of injury-related death, only surpassed by motor vehicle collisions [2]. The World Health Organization (WHO) considered poisoning amongst the top 15 causes of death for individuals ages 5-44 years old and estimated that 99% of the intoxication related fatalities occur in developing countries [1,3]. According to the 2013 Annual Report of the American Association of Poison Control Center, 2,113 cases of fatal intoxications were registered.…”