NACCT Platform Abstracts 2012 - The American Academy of Clinical ...

160
Comparison of exposure fatalities from the medical examiner's office and the poison center
Suzanne Doyon 1 , David Fowler 2
1 University of Maryland School of Pharmacy Maryland Poison Center, Baltimore MD USA
2 Office of the Chief Medical Examiner, Baltimore MD USA
Introduction: The Office of the Chief Medical Examiner (OCME) play a critical role in investigating exposure deaths. In
2010, a collaboration between the OCME and the Maryland Poison Center was started. The type of fatal exposure most
likely to be reported to the poison center has not been studied.
Purpose: Determine and characterize the exposure deaths investigated by the OCME and reported and not reported to the
poison center.
Methodology: A query of the OCME database from January 1 2011 to December 31 2011 (12 months) was performed
using query words that would identify all exposures fatalities. Demographic information including all zip codes, site of death,
cause of death, manner of death, complete toxicologic analysis and field notes were obtained.
Results: A total of 810 poisoning fatalities were examined over a 12-month period. Four hundred ninety (61%) died prehospital;
320 (39%) died in hospital. Of these, 229 died in the emergency department (ED) after presenting in cardiac arrest
without return of spontaneous circulation and 91 died after being admitted to the hospital. Comparison of the 91 hospitalized
exposure deaths is found in Table 1. Twenty six deaths were captured and 65 were not captured by the poison center. There
were 5 hospitalized fatalities in children under 18 years of age. The poison center captured 3 but did not capture one 13 yo
burn victim and one 17 yo heroin overdose.
Table 1. Hospitalized exposure deaths captured and not captured by the poison center.
Reason for
exposure
Captured cases
n=26 (%)
Noncaptured cases and causes of death n=65 (%)
Suicide 9 (60) 6 (40): carisoprodol 1; DoA 3; metoprolol 1; APAP 1
Misuse/abuse 9 (18)
Unknown 4 (33) 8 (66): DoA 7; phenytoin 1
Adverse drug
event
2 (33) 4 (66)
Environmental 0 4 (100): housefires 4
Occupational 1 0
Therapeutic
error
1 0
Other 1 0
DoA: Drugs of Abuse
42 (82): DoA 18; liver failure 12; GI bleed 4; ICH 4; MI 2;sepsis
2; pneumonia 2; others 7
Discussion: Only 11% of exposures deaths investigated by the OCME were hospitalized before dying. These would be the
cases most likley to be reported to poison centers. Hospitals reported 60% of suicides. but only 18% of misuse/abuse resulting
in death. Most of the misuse/abuse cases (57%) suffered from serious other life-threatening conditions (e.g. liver failure,
bleeding,...) which may have influenced the reporting. Adverse drug events and environmental exposures were not frequently
reported to the poison center. Hospitals that chronically underreported were identified.