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. 2022 May-Jun;137(3):463-470.
doi: 10.1177/00333549211008455. Epub 2021 Apr 28.

Accuracy of Medical Examiner's Assessment for Near-Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017-February 2018

Kirsten Vannice  1   2 , Julia Hood  2 , Nicole Yarid  2 , Meagan Kay  2 , Richard Harruff  2 , Jeff Duchin  2
Affiliations

Accuracy of Medical Examiner's Assessment for Near-Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017-February 2018

Kirsten Vannice et al. Public Health Rep. 2022 May-Jun.

Abstract

Objectives: Up-to-date information on the occurrence of drug overdose is critical to guide public health response. The objective of our study was to evaluate a near-real-time fatal drug overdose surveillance system to improve timeliness of drug overdose monitoring.

Methods: We analyzed data on deaths in the King County (Washington) Medical Examiner's Office (KCMEO) jurisdiction that occurred during March 1, 2017-February 28, 2018, and that had routine toxicology test results. Medical examiners (MEs) classified probable drug overdoses on the basis of information obtained through the death investigation and autopsy. We calculated sensitivity, positive predictive value, specificity, and negative predictive value of MEs' classification by using the final death certificate as the gold standard.

Results: KCMEO investigated 2480 deaths; 1389 underwent routine toxicology testing, and 361 were toxicologically confirmed drug overdoses from opioid, stimulant, or euphoric drugs. Sensitivity of the probable overdose classification was 83%, positive predictive value was 89%, specificity was 96%, and negative predictive value was 94%. Probable overdoses were classified a median of 1 day after the event, whereas the final death certificate confirming an overdose was received by KCMEO an average of 63 days after the event.

Conclusions: King County MEs' probable overdose classification provides a near-real-time indicator of fatal drug overdoses, which can guide rapid local public health responses to the drug overdose epidemic.

Keywords: evaluation; overdose; surveillance.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Drugs identified through toxicology testing among confirmed drug overdoses by whether the medical examiners correctly classified the death as a probable overdose, King County, Washington, March 1, 2017–February 28, 2018. A death could involve multiple drug classes. Other opioids and other prescription drugs were defined by the drug(s) identified by toxicology testing that are found in legal prescriptions regardless of whether they were legally procured or illicitly manufactured. All data were extracted from the electronic database of the King County Medical Examiner’s Office. Abbreviation: ME, medical examiner.
Figure 2
Figure 2
Weekly trends in confirmed and probable drug overdose deaths, King County, Washington, March 1, 2017–February 28, 2018. All data were extracted from the electronic database of the King County Medical Examiner’s Office.
See this image and copyright information in PMC

References

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