The role of toxicology interpretations in prevention of sudden death.
Inappropriate combinations of pharmaceutical drugs are often detected in deaths reported to a coroner. However, the involvement of drug combinations in the cause of death can be overlooked in cases when significant natural disease or external injury is also present. This study examined pathology reports and coroner's findings between January 2002 and December 2008. Cases that included exposure to a selection of serotonergic drugs were examined to determine the role of different death investigators in drug-associated deaths in Victoria, Australia. Of the 326 cases identified, the involvement of drugs in the death was discussed to some degree in 66% of cases. Recommendations by the coroner pertaining to death prevention were made in 12 cases (4%). In 16 cases (5%) the drugs were not mentioned in the findings, including at least 11 cases of probable major adverse drug interactions. Death investigations serve an important public health and safety role, however, the potential involvement of drugs in many cases is not always recognized.
Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, 57-83 Kavanagh Street, Southbank, VIC 3006, Australia. jenniferp@vifm.org
Jennifer L
JL
Pilgrim
Dimitri
D
Gerostamoulos
Olaf H
OH
Drummer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002423:Cause of Death; D003645:Death, Sudden / Q000209:etiology / Q000517:prevention & control*; D004347:Drug Interactions; D062787:Drug Overdose / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D004358:Drug Therapy / Q000401:mortality*; D005260:Female; D053593:Forensic Toxicology / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D014739:Victoria; D055815:Young Adult