Data-Based Method to Reduce Unnecessary Autopsies in Suspected Overdose Deaths.

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.