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. 2025 Mar;21(1):229-238.
doi: 10.1007/s12024-024-00819-2. Epub 2024 Apr 29.

Enhanced autopsy triage (EA-Triage) in drug-related deaths: integrating quick toxicological analysis and postmortem computed tomography

Lea Wold Kisbye  1 , Annika Rickert  2 , Jørgen Bo Hasselstrøm  2 , Charlotte Uggerhøj Andersen  2 , Henriette Askjær Lund  2 , Marianne Cathrine Rohde #  2 , Lene Warner Thorup Boel #  2
Affiliations

Enhanced autopsy triage (EA-Triage) in drug-related deaths: integrating quick toxicological analysis and postmortem computed tomography

Lea Wold Kisbye et al. Forensic Sci Med Pathol. 2025 Mar.

Abstract

The objective was to assess the diagnostic accuracy of an enhanced autopsy triage (EA-Triage) setup consisting of postmortem computed tomography (PMCT), simulated quick toxicological analysis (sQTA), external examination, and case information in determining cause of death (COD) in persons with past or current use of illegal drugs (drug-related deaths). Information on drug-related deaths selected for medico-legal autopsy in 2020-2021 at the Department of Forensic Medicine, Aarhus University, Denmark, was analyzed retrospectively. The included cases underwent conventional autopsy, PMCT, and systematic toxicological analysis. A board-certified forensic pathologist, who was blinded to the internal examination and COD from the medico-legal autopsy, determined COD based on the EA-Triage setup. 154 cases with a median age of 40.6 years (range 17-70 years, 82% males) were included. The COD determined by medico-legal autopsy and that determined by EA-Triage matched in 113 cases (73%), including those with an unknown COD. EA-Triage and medico-legal autopsy determined unknown COD in 45 (29%) and 5 cases (3%), respectively. Excluding cases with an unknown COD, EA-Triage predicted COD in 109 cases (71%); of those, 72 (66%) had no unexplained case circumstances or suspicion of a criminal act. In these 72 cases, the CODs determined by EA-Triage and medico-legal autopsy matched in 71 cases (99%), and the sensitivity and specificity for detecting lethal intoxication were 100% and 90%, respectively. EA-Triage showed strong diagnostic accuracy for determining COD in drug-related deaths. This method may be suitable for enhancing preautopsy triage and guiding police investigations at an early stage.

Keywords: Autopsy triage; Cause of death; Forensic pathology; Forensic toxicology; Postmortem computed tomography; Quick toxicological analysis.

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Conflict of interest statement

Declarations. Competing interests: The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flowchart of identified cases according to the inclusion criteria and evaluation by enhanced autopsy triage (EA-Triage) by a board-certified forensic pathologist in the determination of cause of death (COD). Postmortem computed tomography (PMCT) was not performed in three cases, one due to technical issues, one because the body exceeded the scanning capacity, and one because of the prioritization of resources during the COVID-19 pandemic. Systematic toxicological analysis (STA) was not required for three cases. In nine cases, femoral blood (FB) was not available due to decomposition. COD: Cause of death, PMCT: postmortem computed tomography, STA: Systematic toxicologcal analysis, sQTA: simulated quick toxicological analysis, FB: femoral blood
Fig. 2
Fig. 2
Workflow of the enhanced autopsy triage (EA-Triage) setup with integrated postmortem computed tomography (PMCT) and simulated quick toxicological analysis (sQTA) and the corresponding cases of drug-related deaths. Case circumstances could change the outcome independent of the ability of EA-Triage to provide a cause of death (COD). All cases were evaluated using EA-Triage by one of two board-certified forensic pathologists. PMCT findings were categorized as injuries compatible or incompatible with the case. Consequently, each individual injury was assessed in accordance with the case circumstances and medical history for compatibility, e.g., resuscitative efforts. Cases are displayed as n (%) a Quantification included toxicological evaluation of ethanol, carbon monoxide and 88 selected drugs and metabolites (Online Resource 2) b Cases with nonsuspicious circumstances where the COD could be determined through EA-Triage
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