Added value of post-mortem toxicological blood testing in medicolegal death investigations in Amsterdam and surrounding regions, 2017-2018.

IntroductionAccurate determinations of the cause of death are crucial for public health, crime investigations, and social justice. In the Netherlands, cause-of-death determinations rely heavily on external examinations, which can miss substance-related deaths. This study investigates the added value of toxicological blood testing in the determination of the cause and manner of death by forensic physicians in the Netherlands.MethodsCollected blood samples of 642 decedents that were examined by a forensic physician in Amsterdam and surrounding regions underwent toxicological testing. Findings and concluding remarks from the external examination and toxicological testing were compared using descriptive statistics.ResultsBlood samples of 69% of cases tested positive for one or more pharmaceuticals, and 36% tested positive for illicit drugs and/or alcohol. In 55% of cases, toxicological testing revealed substances that were not indicated by the external examination. Its findings also prompted a revision of the initial cause and manner of death in 18 cases (3%).DiscussionKey limitations in this study include that not all detected substances were quantified and a verification bias of the included cases, which may have led to an underrepresentation of unsuspected detections. Nonetheless, despite the constraints of (routine) screening capabilities and the effects of post-mortem degradation and redistribution, this study presented the importance of toxicological blood testing within a multifaceted approach that combines toxicological findings with scene evidence, medical history and the external examination, which is essential for improving the accuracy of cause-of-death determinations by the forensic physician.