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Data-Based Method to Reduce Unnecessary Autopsies in Suspected Overdose Deaths
Nicole D'Anna1, Megan Brown1, Alex K Williamson1,2
1Office of Chief Medical Examiner.
Abstract:
The New York City (NYC) Office of Chief Medical Examiner (OCME) continues to be severely impacted by the ongoing opioid overdose crisis with over 3000 overdose deaths in 2022 alone. The National Association of Medical Examiners (NAME) recommends that autopsies be performed in all suspected overdose deaths, but this practice is difficult to maintain in the face of an unprecedented number of overdose deaths and a national shortage of forensic pathologists. Using an existing database of suspected overdose deaths (SPOT) maintained by the OCME Drug Intelligence and Intervention Group (DIIG), we sought to assess the ability to correctly certify subsets of suspected overdose deaths based only on known history and circumstances, external examination, and toxicology testing (View-Tox) using 6 exclusionary criteria for View-Tox eligibility (suspicion of criminality, suicide, trauma, hypothermia/drowning, epilepsy/seizures, and death in a public location). This process resulted in the exclusion of all homicides, suicides, non-overdose accidents, and most undetermined manner deaths. Of the remaining cases eligible for View-Tox, 99.2% could be correctly certified based only on toxicology testing results and information known before autopsy. This approach to overdose deaths would have resulted in a 32.8% reduction of autopsies in suspected overdose deaths at OCME in 2022.
Insights
The New York City Office of Chief Medical Examiner (OCME) can reduce autopsies for suspected opioid overdose deaths by 32.8% using a toxicology-focused approach (View-Tox). This method accurately certifies most cases without full autopsy, easing the burden on forensic pathologists.
Area of Science:
- Forensic Pathology
- Toxicology
- Public Health
Background:
- The opioid overdose crisis significantly impacts medical examiner offices, leading to an overwhelming number of cases.
- A national shortage of forensic pathologists makes it challenging to perform autopsies on all suspected overdose deaths as recommended.
- The New York City Office of Chief Medical Examiner (OCME) faces severe strain due to over 3000 overdose deaths in 2022.
Purpose of the Study:
- To assess the feasibility of certifying suspected overdose deaths using a limited approach (View-Tox) instead of full autopsies.
- To determine the accuracy of certifying deaths based on history, external examination, and toxicology testing.
- To evaluate the potential reduction in autopsy workload for the OCME.
Main Methods:
- Utilized the Suspected Deaths (SPOT) database from the OCME Drug Intelligence and Intervention Group (DIIG).
- Applied six exclusionary criteria to identify cases eligible for the View-Tox approach.
- Cases were evaluated based on known history, circumstances, external examination, and toxicology results.
Main Results:
- The View-Tox eligibility criteria successfully excluded homicides, suicides, non-overdose accidents, and most undetermined manner deaths.
- Among eligible cases, 99.2% were accurately certified using toxicology results and pre-autopsy information alone.
- Implementing this approach could have reduced autopsies for suspected overdose deaths at OCME by 32.8% in 2022.
Conclusions:
- A View-Tox approach, focusing on toxicology and available information, is highly accurate for certifying many suspected overdose deaths.
- This strategy can significantly decrease the autopsy burden on medical examiner offices during public health crises.
- The findings support a more efficient case management system for overdose deaths, preserving resources and addressing pathologist shortages.
