Abstract
Purpose
The accuracy of cause of death certification is strongly influenced by the quality of post mortem investigations (autopsies). In New Zealand, this can include toxicological investigation at the discretion of the Coroner. Little is known both within New Zealand and internationally about potential selection biases related to Coronial cases not undergoing toxicology investigation.
Methods
A retrospective review of eligible injury-related deaths referred to a Coroner in New Zealand in 2014 was undertaken. Using data collected from the Australasian National Coronial Information System and New Zealand’s Mortality Collection, descriptive analyses were undertaken to understand patterns related to toxicology report requests and patterns within toxicology reports.
Results
In New Zealand in 2014, 25% of 744 Coronial cases for fatal injury in those under 85 years of age did not have corresponding toxicological reports. Reports were more likely to be absent in females (adjusted Odds Ratio (aOR) 1.7, 95%CI 1.0, 2.7), and in decedents aged under 15 and over 65 years (aOR 11.0 and 4.1 respectively). More than half (56%, 95% CI 45%, 67%) of the deaths due to falls did not receive toxicological investigation.
Conclusion
Better understanding of selection biases in Coronial processes helps inform policymakers, researchers, and practitioners of the limitations of available toxicological evidence.
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Availability of data and material
The primary data used for this study was obtained from the National Coronial Information System (https://www.ncis.org.au/). This data is not publicly available. Requests for data can be sent to https://www.ncis.org.au/.
References
Nashelsky MB, Lawrence CH. Accuracy of cause of death determination without forensic autopsy examination. Am J Forensic Medicine Pathol. 2003;24:313–9.
The Office of the Chief Coroner. Annual Report 2019/20. Office of the Chief Coroner. New Zealand: Wellington. https://coronialservices.justice.govt.nz/assets/Documents/Publications/MOJ0216-Chief-Coroner-2019-20-Annual-Report.pdf. Accessed 18 Oct 2021.
National Coronial Information System (NCIS). Explanatory Notes: NCIS; 2019. https://www.ncis.org.au/about-the-data/explanatory-notes/. Accessed 18 Oct 2021.
Langlois NEI, Sully CJ, Edwards S. Turnaround time data for Coronial autopsies – time to complete forensic post mortem examination reports and influencing factors for Australia and New Zealand in 2015 and 2010. Forensic Sci Med Pathol. 2019;15:56–66.
Skopp G. Postmortem toxicology. Forensic Sci Med Pathol. 2010;6:314–25.
Langlois NEI, Ellis SP, Little SD, Hulewicz SB. Toxicologic analysis in cases of possible sudden infant death syndrome: A worthwhile exercise? Am J Forensic Med Pathol. 2002;23:162–6.
Langlois NEI, Gilbert JD, Heath KJ, Winskog C, Kostakis C. An audit of the toxicology findings in 555 medico-legal autopsies finds manner of death changed in 5 cases. Forensic Sci Med Pathol. 2013;9:44–7.
Ferris JAJ. Code of practice and performance standards for forensic and coronial pathologists. Tina Pope Consulting, for New Zealand National Coronial Pathology Service; 2006.
Walter SJ, Bugeja L, Spittal MJ, Studdert DM. Factors predicting coroners’ decisions to hold discretionary inquests. Can Med Ass J. 2012;184:521–8.
Bugeja L, Ibrahim JE, Ferrah N, Murphy B, Willoughby M, Ranson D. The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System. Health Res Policy Systems. 2016;14:28.
Lilley R, McNoe B, Davie G, Horsburgh S, Maclennan B, Driscoll T. Identifying opportunities to prevent work-related fatal injury in New Zealand using 40 years of coronial records: protocol for a retrospective case review study. Inj Epidemio. 2019;6:1–8.
National Centre for Classification in Health (NCCH). The International statistical classification of diseases and related health problems, tenth revision, Australian modification (ICD-10-AM) – sixth edition - tabular list of diseases and alphabetic index of diseases. Sydney: NCCH, Faculty of Health Sciences, The University of Sydney; 2006.
Lilley R, Maclennan B, McNoe B, Davie G, Horsburgh S, Driscoll T. A decade of fatal injuries in workers in New Zealand: insights from a comprehensive national observational study. Inj Prev. 2021;27:124–30.
Ministry of Health. HISO 10001:2017 Ethnicity data protocols. Wellington Ministry of Health. 2021. https://www.health.govt.nz/publication/hiso-100012017-ethnicity-data-protocols. Accessed 18 Oct 2021.
Hedegaard H, Johnson RL, Garnett MF, Thomas KE. The international classification of diseases, 10th revision, clinical modification [ICD–10–CM] external cause-of-injury framework for categorizing mechanism and intent of injury. National Health Statistics Reports: National Center for Health Statistics; 2019.
Coroners Act. 2006. https://www.legislation.govt.nz/act/public/2006/0038/latest/whole.html. Accessed 18 Oct 2021.
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Informat. 2019;95:103208.
StataCorp. Stata Statistical Software: Release 16. College Station TSL. 2019. College Station, TX: StataCorp LLC.
Bill ON. Doctor as murderer: Death certification needs tightening up, but it still might not have stopped Shipman. British Med J. 2000;320:329–30.
Coronial Services of New Zealand. What happens during a post mortem. Wellington; 2017. https://coronialservices.justice.govt.nz/what-happens-during-a-post-mortem/when-the-family-doesnt-want-a-post-mortem/. Accessed 18 Oct 2021.
National Coronial Information System. NCIS Operational Statistics: Document attachment rates - 1 July 2021. Victorian Department of Justice and Community Safety, Australia; 2021. https://www.ncis.org.au/wp-content/uploads/2021/10/NCIS-stats-Document-attachment-October-2021.pdf. Accessed 18 Oct 2021.
Acknowledgements
The authors are grateful to the National Coronial Information System and the Victorian Department of Justice and Community Safety in Australia for the provision of coronial files and to Brandon de Graaf for technical assistance and REDCap setup.
Funding
This work was supported by a University of Otago Division of Health Sciences Summer Research Scholarship. Data collection was supported by a grant from the Health Research Council of New Zealand (HRC 16/173).
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LN contributed to conceptualization, funding acquisition, methodology, data curation, analysis and writing – original draft. GD and RL provided supervision and contributed to conceptualization, funding acquisition, methodology, analysis and writing – review & editing.
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National Coronial Information System (Ref NZ013), the University of Otago Human Ethics Committee (Ref 15/065) and the Health and Disability Ethics Committee (Ref OTA/99/02/008/AM05).
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Nie, L., Davie, G. & Lilley, R. Factors related to absence of toxicological investigation following fatal injury: a retrospective quantitative review of Coronial records in New Zealand. Forensic Sci Med Pathol 17, 643–648 (2021). https://doi.org/10.1007/s12024-021-00422-9
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DOI: https://doi.org/10.1007/s12024-021-00422-9