The value of toxicology in determining cause of death. A study of 400 autopsy cases

Abstract

The interest of a forensic autopsy is the search for the cause of death. However, sometimes doubt suspicion persists about association with toxic substances. In this perspective, it’s important to ask whether such toxicological analyses following a forensic autopsy are important in determining the cause of death. On the other hand, ask yourself, which toxins are most frequently encountered. The question then being is to compare the results of toxicological analyses with the conclusions established during the forensic autopsy. We have tried to show that, during the search for the cause of death, toxicological analyses are essential to assess the participation of xenobiotics in the fatal process.  Materials and methods: This is a retrospective study, descriptive study on the analysis of toxicological results compared with conclusions from forensic autopsies (N=400), performed on requisition from the judicial authority of the competent territory, in the forensic medicine department (thanatology unit) of the university hospital of Sidi Bel Abbés (Algeria) during the period from January 01,2017 to December 31,2019. The sampling is carried out on different body fluids to determine how the person died. We had at our disposal blood (cardiac and peripheral), urine, gastric contents. Results: we obtained on our sample of 400, 274 males for 126 females with a sex ratio of 2.17. The minimum age was 0 days. The maximum age was 93 years, with a mean of 38 years and a standard deviation of 23 years. The natural form of death represented 41%, the unatural form (suicidal, criminal, accidental) represented 37% and the undetermined form represented 23%. According to the direct causes of death, acute cardiorespiratory distress represents the majority, i.e. 78.5%. Cardiopulmonary diseases represent the majority (28%), followed by death of traumatic origin (23.3%), death of asphyxic origin (12%) and having remained undetermined (19%). Requests for toxicological analysis of autopsies, including the establishment of the cause of death requiring the results of toxicological analysis represent (45%). Of all the results received (N=42), we found that the results that came back positive represent 43%, of which the molecules with neuro-psychotropic effects represent the majority of 50%, then alcohol (20%) and cannabis (10%). Conclusion: In current forensic practice, the performance and analysis of samples for toxicological purposes appears to be an essential step, in order to better understand the circumstances of unatural deaths, and to clarify some situations for which the cause of death does not appear obvious. The evaluation of the nature of the substances most frequently encountered in search for causes of death can be evaluated over time according to the modes of prescription.