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Walters JK, Repp KK, Mew MC. Alcohol and drug presence in traffic crash fatalities before and after the COVID-19 pandemic: Evaluation of the fatality analysis reporting system (FARS) and linked medical examiner-vital records data in Clackamas, Multnomah, and Washington County, Oregon, 2019-2021. Forensic Sci Int Synerg 2024; 8:100468. [PMID: 38707715 PMCID: PMC11066131 DOI: 10.1016/j.fsisyn.2024.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024]
Abstract
Traffic fatalities, with and from increased risky behaviors (reduced seat belt use, increased impairment from licit and illicit substances), have been increasing, especially during the COVID-19 pandemic. Death certificates are a major source of epidemiologic data in the United States, but have known underreporting of drug and alcohol presence. The Fatality Analysis Reporting System (FARS) is one major source of data on fatal crashes with intoxication. This study links FARS data for three counties in Oregon (2019-2021) with local medical examiner and death certificate data (FARS source data) and compares their concordance with blood alcohol concentration and toxicology for three major drug classes by year. For drivers only, our study finds good concordance between FARS and its source data in 2019 but poor concordance in 2020. This discordance may impact future analysis of impaired crash deaths, and we list some suggestions for amelioration.
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Affiliation(s)
- Jaime K. Walters
- Multnomah County Health Department, Public Health Division, Community Epidemiology Services, USA
| | - Kimberly K. Repp
- Washington County Health and Human Services Department, Public Health Division, Research, Analytics, Informatics, and Data (RAID) Program), USA
| | - Molly C. Mew
- Clackamas County Health, Housing and Human Services Department, Public Health Division, USA
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Smiley-McDonald HM, Keyes KA, Wire S, Greenwell K, Santos NA, Ropero-Miller JD. The impacts of governing agency: A comparison of resources in the patchwork of medicolegal death investigation systems. Forensic Sci Int Synerg 2024; 8:100467. [PMID: 38638873 PMCID: PMC11024903 DOI: 10.1016/j.fsisyn.2024.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
In the United States, medical examiners and coroners (MECs) fill critical roles within our public health and public safety systems. These professionals are primarily charged with determining the cause and manner of death as they investigate deaths and respond to associated scenes and mass fatalities and can also help identify trends in public health crises through medicolegal death investigations. Despite their instrumental role, they are organized in disparate systems with varying governing structures, functions, staffing, caseload, budget, and access to resources. This paper examines data from the 2018 Census of Medical Examiner and Coroners to evaluate MEC operations in the United States. The findings show that MEC offices' organizational and operational governance structures greatly influence resources, workloads, and access to information and services. Standalone MEC offices were generally better resourced than those affiliated with law enforcement, public health, forensic science, district attorneys, or other agencies.1.
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Affiliation(s)
| | - Kelly A. Keyes
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sean Wire
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kathryn Greenwell
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Nelson A. Santos
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Jeri D. Ropero-Miller
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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3
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Ascolese MA, Keyes KA, Ropero-Miller JD, Wire SE, Smiley-McDonald HM. Mass fatality and disaster response preparedness across medical examiner and coroner offices in the United States. Forensic Sci Int Synerg 2024; 8:100462. [PMID: 38439787 PMCID: PMC10909695 DOI: 10.1016/j.fsisyn.2024.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
With the rise of mass fatalities and disasters, access to mass fatality and disaster planning trainings and resources available to medical examiners and coroners (MECs) in the United States should be reviewed. This paper provides a necessary update on the extent of access to these resources by analyzing data from the 2018 Census for Medical Examiner and Coroner Offices (CMEC). Results show that a high percentage of respondents have access to mass fatality and disaster planning trainings/resources; however, the access is disproportionate. Respondents in the Midwest and South-and those with smaller populations-have less access to resources, while agencies with larger budgets and more full-time staff have more access to resources. This paper discusses potential contributing factors for these disparities, but the data only begin to elucidate gaps in access to mass fatality and disaster planning trainings/resources for MECs and where further research should be conducted.
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Affiliation(s)
- Micaela A. Ascolese
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Kelly A. Keyes
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Jeri D. Ropero-Miller
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sean E. Wire
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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4
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Abasilim C, Friedman LS, Karch L, Holloway-Beth A. Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic. Ann Epidemiol 2024; 90:35-41. [PMID: 38501569 DOI: 10.1016/j.annepidem.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/19/2023] [Accepted: 10/26/2023] [Indexed: 03/20/2024]
Abstract
PURPOSE This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems. METHODS We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases. RESULTS The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses. CONCLUSIONS We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lee S Friedman
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Lydia Karch
- Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
| | - Alfreda Holloway-Beth
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL; Epidemiology Unit, Cook County Department of Public Health, Bridgeview, IL
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5
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Brouwer AF, Wilson AM, Martin ET, Zelner J, Lephart PR, Jaworski A, Schmidt CJ. Respiratory virus infections in decedents in a large, urban medical examiner's office. Public Health 2023; 224:118-122. [PMID: 37757630 DOI: 10.1016/j.puhe.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Most respiratory virus surveillance relies on medically attended respiratory illness, but an understanding of the true patterns of infection independent of care-seeking behaviour would enhance clinical and public health responses to respiratory virus outbreaks. We evaluated the potential of decedent surveillance by estimating the burden of respiratory virus infection in decedents in a large, urban medical examiner's office. STUDY DESIGN Observational. METHODS In 2020-2022, we tested nasopharyngeal swabs from 4121 decedents in Detroit, Michigan for 15 respiratory viruses, including SARS-CoV-2, respiratory syncytial virus, and influenza virus A and B. We analysed infection prevalence over time and by age, sex, race/ethnicity, and manner of death. RESULTS Of 4113 valid tests, 30.2% were positive for at least one virus, and 6.1% were positive for multiple viruses. All viruses were detected except for influenza A/H1N1 and influenza B. The most prevalent viruses were SARS-CoV-2 (15.7%), rhinovirus (11.2%), and adenovirus (4.9%), which were detected in all months. Most viruses exhibited decreasing prevalence with age, higher prevalence among Black and Hispanic than among White decedents and lower prevalence among deaths from natural causes; SARS-CoV-2 was a notable exception to the patterns by age and manner of death, instead reflecting community trends in catchment counties. CONCLUSIONS There was high prevalence and diversity of respiratory viruses in decedents entering a large, urban medical examiner's office. Decedent surveillance could offer a clearer picture of the true underlying burden of infection, motivating public health priorities for intervention and vaccine development, and augmenting data for real-time response to respiratory virus outbreaks.
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Affiliation(s)
- A F Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States.
| | - A M Wilson
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - E T Martin
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - J Zelner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States; Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States
| | - P R Lephart
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - A Jaworski
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States; Wayne County Medical Examiner's Office, Detroit, MI, United States
| | - C J Schmidt
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States; Wayne County Medical Examiner's Office, Detroit, MI, United States
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6
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Cullip M, Sarti AJ, Weiss MJ, Whittingham H, Meade MO. The Intersection of Death Investigation and Organ Donation Systems: A Scoping Review. Acad Forensic Pathol 2022; 12:65-74. [PMID: 35799995 DOI: 10.1177/19253621221106892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/20/2022] [Indexed: 11/15/2022]
Abstract
Introduction Death investigators (DIs) such as coroners, medical examiners, and forensic pathologists play important and evolving roles in deceased organ donation. DIs communicate with organ donation organizations (ODOs) to gather case-specific information and release or restrict organs depending on the medicolegal requirements. This scoping review aims to identify the breadth of roles and decision-making processes that may facilitate or hinder deceased donation in DI cases. Methods This study was conducted using a scoping literature review and subsequent thematic analysis. Results Thirty-one eligible papers described 8 common themes with region-specific nuances. These include: 1) shared (ODO and DI) protocols for early communication around each case; 2) shared standards and education for death investigation practices related to organ donation; 3) DI support staff or teams to facilitate organ donation; 4) DI authority to order additional testing and imaging before organ recovery; 5) donation-specific legislation to enhance DI and/or ODO operations; 6) legally trained DI authority to veto medical decisions to proceed with organ donation; 7) DI attendance at organ recovery; and 8) surgeons recording specific DI evidence during organ recovery. Conclusion These findings have cultural and resource-allocation implications and expose gaps in the international literature describing practices at the intersection of deceased organ donation and death investigation. A better understanding of the rationale and execution of various systems for DI and ODO cooperation may serve to advance both organ donation and death investigation.
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F. Wilson R, Klevens J, Fortson B, Williams D, Xu L, Yuan K. Neonaticides in the United States-2008-2017. Acad Forensic Pathol 2022; 12:3-14. [PMID: 35694006 PMCID: PMC9179000 DOI: 10.1177/19253621221077870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 01/16/2022] [Indexed: 11/16/2022]
Abstract
Objective This study examines factors associated with homicide in the first 24 hours of life (i.e., neonaticide) in the United States. Methods National Vital Statistics System (NVSS) linked birth-infant death data, for 50 states and the District of Columbia, from 2008 through 2017, were used to examine characteristics associated with neonaticide. National Violent Death Reporting System (NVDRS) data were used to examine circumstances of neonaticides that occurred in 14 states. Circumstances of neonaticides are described, and rates for maternal and infant characteristics are presented as rates per 100,000 person-years. Results Among neonaticide victims in NVSS (N = 81), those of mothers who are young, unmarried, non-Hispanic, Black, and have lower education levels, are at an increased risk of neonaticide. Further, among mothers in NVDRS who committed neonaticide (N = 42), 66.7% were known to have given birth at a residence, without medical assistance. Approximately three-fourths (73.8%; n = 31) concealed their pregnancy, with 35.7% (n = 15) disposing of their infants in a trash receptacle after giving birth. Additionally, more than half of neonaticide victims were tested for alcohol, opioids, amphetamines, and cocaine, but a relatively small number tested positive for these substances. Conclusions Results highlight the importance of identifying factors that elevate risk to neonates so these deaths can be prevented. As such, many mothers who commit neonaticide are young, unmarried, and conceal their pregnancy; thus, programs that prevent teen pregnancy, decrease shame and stigma associated with birth to young mothers, and provide support and resources to pregnant women, may help prevent neonaticide.
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Affiliation(s)
- Rebecca F. Wilson
- Rebecca F. Wilson PhD, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341;
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8
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Harty MP, Gould SW, Harcke HT. Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States. Pediatr Radiol 2021; 51:1051-1060. [PMID: 33999245 DOI: 10.1007/s00247-020-04833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.
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Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
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9
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Ehsani JP, Michael JP, Duren M, Shields WC, Compton RP, Fowler D, Smith G. Drug presence in driving deaths in Maryland: Comparing trends and prevalence in medical examiner and FARS data. Accid Anal Prev 2021; 154:106066. [PMID: 33714054 PMCID: PMC8375081 DOI: 10.1016/j.aap.2021.106066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/22/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Accurate and reliable information on drug use by road users is essential to inform safety policy development but the reliability of national data has been questioned. There are two primary repositories of drug test information from fatal motor vehicle crashes in Maryland: (1) the Fatality Analysis Reporting System (FARS), which is a national crash database managed by the US Department of Transportation, and (2) the Maryland Medical Examiner (ME). In this study, we compared drug test information for people killed in crashes in Maryland between the FARS system and ME from 2006 - 2018. As ME records are the primary source for the FARS data from Maryland, these two data sets should be closely correlated. We used probabilistic linkage to match FARS and ME cases and compared matched cases by individual drug group. Matching was achieved on 83 % of cases (N = 4803 matched pairs). ME data consistently indicated higher overall incidence and trends in the presence of depressants, narcotics, and stimulants in crash deaths. Sensitivity analysis using both strict and relaxed matching criteria did not change this result. Road safety policy and prevention efforts for crashes involving drugs and alcohol require an accurate understanding of both long-term trends and year-to-year changes in drug prevalence. These findings demonstrate the potential value of using ME data as source of drug test information for crash deaths in the United States.
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Affiliation(s)
- Johnathon P Ehsani
- Department of Health Policy and ManagEment, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Jeffrey P Michael
- Department of Health Policy and ManagEment, Johns Hopkins Bloomberg School of Public Health, United States
| | - Michelle Duren
- Department of Health Policy and ManagEment, Johns Hopkins Bloomberg School of Public Health, United States
| | - Wendy C Shields
- Department of Health Policy and ManagEment, Johns Hopkins Bloomberg School of Public Health, United States
| | | | - David Fowler
- Former Chief Medical Examiner at Office Of the Chief Medical Examiner Maryland, United States
| | - Gordon Smith
- Department of Epidemiology, West Virginia University School of Public Health, United States
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Moretti M, Malhotra A, Visonà SD, Finley SJ, Osculati AMM, Javan GT. The roles of medical examiners in the COVID-19 era: a comparison between the United States and Italy. Forensic Sci Med Pathol 2021; 17:262-70. [PMID: 33582936 DOI: 10.1007/s12024-021-00358-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 01/06/2023]
Abstract
Italy and the United States are two of the countries most affected by SARS-CoV-2 (COVID-19), with more than 240,760 confirmed cases in Italy and 2,699,658 in the United States (as of July 2, 2020). The current COVID-19 pandemic has led to substantial changes in many fields of medicine, specifically in the forensic discipline. Medicolegal activities related to conducting autopsies have been largely affected by the COVID-19 pandemic. Postmortem examinations are generally discouraged by government regulations due to the risk of spreading the disease further through the handling and dissection of bodies from patients who succumbed to COVID-19 infection. There is a paucity of data regarding the persistence of SARS-CoV-2 in bodies, as well as concerning the reliability of swabbing methods in human remains. On the other hand, the autopsy is an essential tool to provide necessary information about the pathophysiology of the disease that presents useful clinical and epidemiological insights. On this basis, we aim to address issues concerning general medical examiner/coroner organization, comparing the Italian and American systems. We also discuss the pivotal roles of forensic pathologists in informing infectious disease surveillance. Finally, we focus on the impact of COVID-19 emergency on medicolegal practices in Italy and the United States, as well as the responses of the forensic scientific community to the emerging concerns related to the pandemic. We believe that stronger efforts by authorities are necessary to facilitate completing postmortem examinations, as data derived from such assessments are expected to be paramount to improving patient management and disease prevention.
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Cottengim C, Parks S, Rhoda D, Andrew T, Nolte KB, Fudenberg J, Sens MA, Brustrom J, Payn B, Shapiro-Mendoza CK. Protocols, practices, and needs for investigating sudden unexpected infant deaths. Forensic Sci Med Pathol 2019; 16:91-98. [PMID: 31741206 DOI: 10.1007/s12024-019-00196-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 12/01/2022]
Abstract
Understanding case identification practices, protocols, and training needs of medical examiners and coroners (MEC) may inform efforts to improve cause-of-death certification. We surveyed a U.S.-representative sample of MECs and described investigation practices and protocols used in certifying sudden unexpected infant deaths (SUID). We also identified MEC training and resource needs. Of the 377 respondents, use of the SUID Investigation Reporting Form or an equivalent was 89% for large, 87% for medium, and 52% for small jurisdictions. Routine completion of infant medical history, witness interviews, autopsy, photos or videos, and family social history for infant death investigations was ≥80%, but routine scene re-creation with a doll was 30% in small, 64% in medium, and 59% in large offices. Seventy percent of MECs reported infant death investigation training needs. Increased training and use of standardized practices may improve SUID cause-of-death certification, allowing us to better understand SUID.
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Affiliation(s)
- Carri Cottengim
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA.
| | - Sharyn Parks
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA
| | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, formerly at Battelle, Columbus, OH, USA
| | - Tom Andrew
- Office of Chief Medical Examiner, Concord, NH, USA
| | - Kurt B Nolte
- Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - John Fudenberg
- Clark County Office of the Coroner/Medical Examiner, Las Vegas, NV, USA
| | - Mary Ann Sens
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | | | - Betsy Payn
- University of Washington, Seattle, WA, USA
| | - Carrie K Shapiro-Mendoza
- Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, N.E. MS S107-2, Chamblee, GA, 30341, USA
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12
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Posey BM, Neuilly MA. A fatal review: Exploring how children's deaths are reported in the United States. Child Abuse Negl 2017; 72:433-445. [PMID: 28918234 DOI: 10.1016/j.chiabu.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/09/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
Child death reports are the leading data source used to orchestrate child fatality prevention policy. Therefore, the way in which child death is reported is crucial to how we sustain life. We sought to assess the systematic ways in which death is reported for children. Based on a qualitative analysis of medico-legal investigation reports collected from a medical examiner's office and a coroner's office, we examined several indicators of data completeness, quality, site organizational structure, and consistency. We found stark differences between the two sites, as well as issues regarding death diagnosis certainty, and a general lack in consistency in the reports' content, as well as procedures performed post-mortem. We conclude that there are some flaws in our death reporting system for child populations, which have the potential to hinder reliability and accuracy of these death reports, as well as thwart their overall usefulness in prevention policies.
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Affiliation(s)
- Brianne M Posey
- Washington State University, Department of Criminal Justice and Criminology, Washington State University, Johnson Tower 706, Pullman, WA 99164-4872, United States.
| | - Melanie-Angela Neuilly
- Washington State University, Department of Criminal Justice and Criminology, Washington State University, Johnson Tower 721, Pullman, WA 99164-4872, United States.
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13
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Tharp-Myers AM, Hobron K, Orr R. The Utility of a Prescription Monitoring Program in Death Investigation: The Virginia Experience. Acad Forensic Pathol 2017; 7:73-79. [PMID: 31239958 DOI: 10.23907/2017.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/06/2017] [Indexed: 11/12/2022]
Abstract
The Virginia Prescription Monitoring Program (VPMP) has been in effect since 2002, providing reports for prescribers, pharmacists, and other stakeholders in the growing opioid epidemic. The Office of the Chief Medical Examiner is one such stakeholder and has found great efficacy in the program in investigating suspected drug-related deaths. This review examines the origins of the VPMP, its benefits, and limitations for use during death investigation.
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Affiliation(s)
| | | | - Ralph Orr
- Virginia Department of Health Professions - Prescription Monitoring Program
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14
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Johnson MG, Brown S, Archer P, Wendelboe A, Magzamen S, Bradley KK. Identifying heat-related deaths by using medical examiner and vital statistics data: Surveillance analysis and descriptive epidemiology - Oklahoma, 1990-2011. Environ Res 2016; 150:30-37. [PMID: 27236569 DOI: 10.1016/j.envres.2016.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Approximately 660 deaths occur annually in the United States associated with excess natural heat. A record heat wave in Oklahoma during 2011 generated increased interest concerning heat-related mortality among public health preparedness partners. We aimed to improve surveillance for heat-related mortality and better characterize heat-related deaths in Oklahoma during 1990-2011, and to enhance public health messaging during future heat emergencies. METHODS Heat-related deaths were identified by querying vital statistics (VS) and medical examiner (ME) data during 1990-2011. Case inclusion criteria were developed by using heat-related International Classification of Diseases codes, cause-of-death nomenclature, and ME investigation narrative. We calculated sensitivity and predictive value positive (PVP) for heat-related mortality surveillance by using VS and ME data and performed a descriptive analysis. RESULTS During the study period, 364 confirmed and probable heat-related deaths were identified when utilizing both data sets. ME reports had 87% sensitivity and 74% PVP; VS reports had 80% sensitivity and 52% PVP. Compared to Oklahoma's general population, decedents were disproportionately male (67% vs. 49%), aged ≥65 years (46% vs. 14%), and unmarried (78% vs. 47%). Higher rates of heat-related mortality were observed among Blacks. Of 95 decedents with available information, 91 (96%) did not use air conditioning. CONCLUSIONS Linking ME and VS data sources together and using narrative description for case classification allows for improved case ascertainment and surveillance data quality. Males, Blacks, persons aged ≥65 years, unmarried persons, and those without air conditioning carry a disproportionate burden of the heat-related deaths in Oklahoma.
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Affiliation(s)
- Matthew G Johnson
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Acute Disease Service, Oklahoma State Department of Health, Oklahoma City, OK, USA.
| | - Sheryll Brown
- Injury Prevention Service, Oklahoma State Department of Health, Oklahoma City, OK, USA
| | - Pam Archer
- Injury Prevention Service, Oklahoma State Department of Health, Oklahoma City, OK, USA
| | - Aaron Wendelboe
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sheryl Magzamen
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kristy K Bradley
- Office of the State Epidemiologist, Oklahoma State Department of Health, Oklahoma City, OK, USA
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Ely SF. Sudden Death Related to Diabetes Mellitus: Current and Emerging Relevance to the Forensic Pathologist. Acad Forensic Pathol 2016; 6:154-163. [PMID: 31239887 PMCID: PMC6506998 DOI: 10.23907/2016.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2016] [Accepted: 04/25/2016] [Indexed: 11/12/2022]
Abstract
While diabetes mellitus (DM) has historically accounted for substantial worldwide morbidity and mortality, new and evolving epidemiologic trends are forcing the scientific community to view it as a type of emerging disease. This review will summarize the pathophysiology of the disease, present an update of current national statistics and changing epidemiologic patterns, discuss how DM might specifically lead to acute deaths falling under the jurisdiction of the medical examiner/coroner, and suggest a medicolegal standard of practice to maximize their capture and reporting.
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Affiliation(s)
- Susan F. Ely
- Office of Chief Medical Examiner of the City of New York -
Forensic Medicine
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