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Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends


There is a paucity of research examining the utility of forensic toxicology in the investigation of premature external cause deaths of residents in nursing homes. The aim of this study is to describe the frequency and characteristics of toxicological analysis conducted in external cause (injury-related) deaths amongst nursing home residents in Victoria, Australia. This study was a retrospective cohort study examining external cause deaths among nursing home residents during the period July 1, 2000 to December 31, 2012 in Victoria, Australia, using the National Coronial Information System (NCIS). The variables examined comprised: sex, age group, year-of-death, cause and manner of death. One-third of deaths among nursing home residents in Victoria resulted from external causes (n = 1296, 33.3%) of which just over one-quarter (361, 27.9%) underwent toxicological analysis as part of the medical death investigation. The use of toxicological analysis varied by cause of death with a relatively low proportion conducted in deaths from unintentional falls (n = 286, 24.9%) and choking (n = 36, 40.4%). The use of toxicological analysis decreased as the decedents age increased. Forensic toxicology has the potential to contribute to improving our understanding of premature deaths in nursing home residents however it remains under used and is possibly undervalued.

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Corresponding authors

Correspondence to Georgia Aitken or Briony Murphy.

Ethics declarations


This work was supported by: Department of Health and Human Services, Aged Care Branch, Victoria, Australia; and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collections, analysis and preparation of paper.

Disclosure of potential conflicts of interest

The authors declare that they have no conflict of interest. The authors are affiliated and employed by the Department of Forensic Medicine, Monash University, which is also a funding source. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any agency or departments of the Australian Federal Government, the State Government of Victoria, Monash University, the Victorian Institute of Forensic Medicine or the Coroners Court of Victoria. The authors have no other potential financial or personal interests that may constitute a source of bias.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The broader cohort study received ethics approval from the Victorian Institute of Forensic Medicine Research Advisory Committee (RAC 011/13). The Department of Justice Human Research Ethics Committee granted approval for access to the NCIS (CF/13/8187).

Informed consent

This study utilizes existing medico-legal data of deceased subjects for the purpose of public health research, as such the requirement for informed consent has been waived by the approving Human Research Ethics Committee on the balance of harms and benefits to society.

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Aitken, G., Murphy, B., Pilgrim, J. et al. Frequency of forensic toxicological analysis in external cause deaths among nursing home residents: an analysis of trends. Forensic Sci Med Pathol 13, 52–57 (2017).

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  • Older adults
  • Nursing home
  • Forensic toxicology
  • Medico-legal investigations
  • Injury-related deaths