Distribution of ethanol in postmortem liver

The analysis of multiple specimens for ethanol has become a necessary and accepted practice in postmortem forensic toxicology. The correlation between blood and various body fluids has been well documented. However, there is little data on the distribution of ethanol in specimens such as the liver. In postmortem cases where blood is unavailable or contaminated, liver may be used for alcohol and drug analyses. This study reports the analysis, by head space gas chromatography, of heart blood and liver specimens for ethanol from 103 postmortem cases. The average liver/heart blood ratio in cases with a blood alcohol level (BAC) > or = 0.04 g/dL was 0.56, SD = 0.30, with a range of 0-1.40.

Age, sex, and blood alcohol concentration of killed and injured pedestrians

The relationships between age, sex, and blood alcohol concentration were examined among all adult pedestrians fatally injured in South Australia from 1981 to 1992 inclusive and among all adult pedestrians admitted to a Level 1 trauma center from August 1985 to July 1987. Among the 400 fatalities and 217 admissions, respectively, 68% and 60% were male, 35% and 21% were over 65 years of age, and 38% and 29% had a BAC of .10 or above. Three distinct high-risk groups of adult pedestrians were identified: elderly sober pedestrians, young and middle-aged intoxicated males, and male and female teenagers. Temporal trends in numbers, rates, and extent of alcohol involvement of driver and pedestrian fatalities were examined for the years 1981 to 1992: the numbers and rates of driver and, in particular, pedestrian fatalities have decreased over the last decade, but the extent of alcohol involvement has declined significantly only among fatally injured drivers. Comparisons of the extent of alcohol involvement among fatally injured pedestrians, drivers, passengers, and motorcycle riders showed that alcohol involvement, particularly at the higher levels of blood alcohol concentration, was most prevalent among pedestrians.

Alcohol, drugs, and impairment in fatal traffic accidents in British Columbia

Blood samples and accident records of 41 female and 186 male fatally injured drivers were examined. Analyses suggested that drugs other than alcohol are causally related to fatal traffic accidents in British Columbia. Toxicologies showed: 37% alcohol only, 11% alcohol and drugs, and 9% drugs only. The most frequently found drugs were: 48% alcohol, 13% tetrahydrocannabinol or its metabolites (THC/THCCOOH), 4% cocaine, and 5% diazepam. In addition, alcohol-only impairment was missed by investigating police officers in many cases, impairment by alcohol and drugs was mistakenly identified as alcohol-only impairment, and drug-only impairment was misclassified as "driving without due care and attention".

[Alcohol and traffic safety--study of epidemiology (II. 1990/1991 status]

With the co-operation of a further 13 institutes and as a continuation of our own epidemiological-statistical survey, we recorded the total and relative distribution (frequency profile) of the blood alcohol concentration of car drivers for the 3rd quarter 1990 and the 1st quarter 1991. The participating institutes recorded almost 27,000 blood samples and compared them with results of the first part of the study (1989). The survey dealt separately with sex-, age- and time of day-distribution of drivers involved and not involved in road accidents. One of our repeatedly presented field research into the problem of "alcohol and road safety", once again, provided to be a useful method in the run-up to the unprejudiced alcohol test which we are striving for. We noticed characteristic changes in the frequency profiles of the old and the new counties (Bundesländer) in Germany in the 1st (1989) and the 2nd (1990/91) report of the study. The results of Police supervisory operations in the administrative district of Cologne have basically given useful indications as to their epidemiological-statistical value as evidence.

Drug abuse and intoxication in alcoholics

The frequency of drug, alcohol and combined alcohol/drug intoxication in forensic autopsy material is described. Alcoholics had frequently abused drugs; the cause of death was drug intoxication in 12%, combined alcohol/drug intoxication in 13%, and alcohol intoxication only in 4%. The manner of death was different in the various groups as it was almost equally stated as accident, suicide and unascertainable, respectively, with only drugs involved, whereas accidents were the predominant features in the combined alcohol/drug intoxication among alcoholics. In controls, accidents predominated on both types of intoxication. The alcoholics seemed to be more 'deliberately' choosing suicide with drugs, while both alcoholics and controls need more information with regard to the dangers of mixing alcohol and drugs. The frequency of combined alcohol and drug intoxication was much higher in alcoholics.

Alcohol use and injury severity in trauma patients

Trauma is one of the leading causes of morbidity and mortality in the U.S. and alcohol makes a significant contribution to this problem. Alcohol has been demonstrated to increase the incidence of trauma through its ability to alter behavior and impair motor performance. Its effect on the severity of trauma has been more controversial. This study examines the impact of acute intoxication on injury severity by retrospectively reviewing 12 months of trauma admissions (n = 1957) to a Level I trauma center for Injury Severity Score, mortality rate, discharge destination and length of hospital stay. When intoxicated versus non-intoxicated patients were compared, no differences were found in ISS, mortality, or incidence of being discharged to home. However, length of stay was significantly shorter for intoxicated patients. This study supports the concept that acutely intoxicated trauma victims suffer as many consequences as non-intoxicated patients, with the exception of length of stay. A discussion of these findings along with other reports on injury severity and alcohol use is included at the end of the paper.

[Alcohol, drugs and narcotics in suicides in the Aarhus police district]

For a period of one year all suicides in Aarhus police district were investigated with a view to identifying the presence of alcohol or drugs in the body of the deceased. Fifty-one suicides occurred, 46 of which were examined. One third of the suicides were due to poisoning and one fourth to hanging. Alcohol was detected in 20% and drugs or narcotics were found in approximately 60%. The most frequent findings were benzodiazepines, analgetics, antidepressants and carbon monoxide. Approximately 40% of the deceased had received psychiatric treatment.

[Frequently misinterpreted: blood alcohol concentrations in (sudden) natural and unnatural death]

The aim of our study was to gain more knowledge about the significance of acute alcoholization at the moment of death. The blood-alcohol concentrations of all sudden unexpected and nonnatural fatalities that were investigated at the Institute of Legal Medicine in Hamburg (5044 fatalities with an age below 60 years: 1177 females, 3867 males) were tested in a prospective 5-year-series (1989-1993). Measurable blood-alcohol concentrations (at least > or = 0.1 / 1000) were found in 30.2% of all deceased. Higher concentrations of > 2 / 1000 existed in 436 cases (8.6%). Alcohol prevalence and the amount of alcoholization are discussed with respect to age, sex and the manner of death (sudden natural death, accident, suicide, homicide). Alcohol as a relevant factor in sudden/unexpected death and nonnatural death seems to be underestimated. Only a small proportion of these cases are elucidated by way of routine police investigations or by the insurance companies.

Alcohol intoxication in young children

This article presents two cases of severe ethyl alcohol intoxication in pediatric patients, with one of these cases resulting in the death of a child. A review of the current literature is provided along with a comparison of our regional poison control centers and the national intoxication statistics regarding pediatric alcohol ingestion. Medical evaluation is recommended for all symptomatic children; hourly observations x 6 h are recommended for asymptomatic children.

The risk of dying in alcohol-related automobile crashes among habitual drunk drivers

BACKGROUND

Reports suggest that people who drive while intoxicated by alcohol may do so repeatedly. We hypothesized that persons arrested for driving while impaired might be at increased risk for death in an alcohol-related motor vehicle crash. To evaluate this possibility, we studied the deaths of drivers in alcohol-related motor vehicle accidents in North Carolina over a 10-year period.

METHODS

We compared drivers who died in motor vehicle crashes from 1980 through 1989 and who had blood alcohol concentrations of at least 20 mg per deciliter (4.3 mmol per liter), referred to as the case drivers, with those who died in crashes but had blood alcohol concentrations below 20 mg per deciliter, referred to as the control drivers. We identified case drivers and control drivers through the state Medical Examiner System. We then searched North Carolina driver-history files for the five years before each death to identify arrests for driving while impaired.

RESULTS

We linked a total of 1646 case drivers and 1474 control drivers to their driver-history files. Case drivers were more likely than control drivers to have been arrested for driving while impaired (26 percent vs. 3 percent). After we controlled for potential confounding variables, case drivers 21 to 34 years of age were 4.3 times more likely (95 percent confidence interval, 2.7 to 6.8) than control drivers to have been arrested for driving while impaired; case drivers 35 years of age or older were 11.7 times more likely (95 percent confidence interval, 6.8 to 20.1). The strength of the association appeared to increase with the number of prior arrests. Case drivers were also more likely than the general population of currently licensed drivers to have been arrested.

CONCLUSIONS

Arrests for driving while impaired substantially increase the risk of eventual death in an alcohol-related crash. Aggressive intervention in the cases of people arrested for driving while impaired may decrease the likelihood of a future fatal alcohol-related crash.

Age, sex, and blood alcohol concentration of killed and injured drivers, riders, and passengers

The relationships between type of road user, sex, age, and blood alcohol concentration (BAC) were examined among 1,389 adult vehicle occupants and motorcyclists fatally injured in crashes within South Australia from 1985 to 1992, inclusive, and among 1,573 adult vehicle occupants and motorcyclists admitted to a Level-1 trauma centre from August 1985 to July 1987. The relationships between BAC and both day of week of crash and the number of vehicles involved were determined among fatalities, whereas among admissions, duration of hospitalization and type of unit to which the casualty was admitted were also examined. BACs of .08 g/100 mL or higher were found in 38% of killed and 30% of injured drivers, 37% and 27% of passengers, and 35% and 22% of male motorcycle riders. Alcohol involvement was almost nonexistent among the elderly. The finding that the proportion of injured motorcyclists was similar to that of drivers is consistent with motorcyclists' increased risk of injury even in relatively minor crashes. Male motorcycle riders were found to be significantly younger than male drivers. They were also significantly less likely to have been drinking and, if they had been drinking, their mean BAC was significantly lower. The results are also consistent with the well-established observations that alcohol involvement is greater in single-vehicle crashes and in crashes occurring on weekends. Average duration of hospitalization was not found to differ between types of road user or between those with a BAC above and below .08 g/100 mL.

Alcohol in fatally injured bicyclists

Bicycling injury results in about 580,000 emergency room visits and 900 deaths each year in the United States. Alcohol involvement in bicycling injury has not been well documented in the literature. Using data from the Fatal Accident Reporting System, blood alcohol concentrations (BACs) among fatally injured bicyclists ages 15 years or older were examined for the years 1987-1991. Of 1,711 bicyclists who were killed at age 15 or older and tested for alcohol, 32% were positive and 23% legally intoxicated. Adjusted for age, time of crash, and other variables, male decedents were 3.3 times [95% confidence interval (CI) 2.1, 5.1] as likely as female decedents to be BAC positive, and 3.9 times (95% CI 2.2, 6.8) as likely to be legally intoxicated. Decedents ages 25 to 34 and those who died from nighttime crashes also had significantly increased likelihood of being BAC positive and being legally intoxicated. Even among decedents aged 15-19, who were legally prohibited from drinking, 14% had positive BACs. Further studies are needed to confirm the causal relationship between alcohol use and bicycling injury and to better understand the factors related to drinking and biking. The role of alcohol should be seriously considered in developing strategies of bicycling injury control and prevention.

[Analysis of hospital mortality related to alcoholic intoxication and alcoholism for 1991-1993 (according to autopsy results)]

The conclusion is made about the permanent growth of the percentage of lethal cases connected with alcoholism, particularly in 1993. Among persons dying from alcoholism the percentage of young people and women is increased. Several unusual cases are described.

[Mortality among drug addicts 1980-1989. A comparative study of fatal poisonings among drug addicts examined at the institutes of forensic medicine in Arhus and Oslo]

Cases of fatal poisonings among drug addicts examined at the Institutes of Forensic Medicine in Aarhus (n = 238) and Oslo (n = 263) are compared and discussed on the basis of the availability of illicit and medical drugs during the 1980s. The annual number of deaths in age groups over 30 years increased in both countries. Heroin and/or morphine-related deaths comprised one-third of the Danish material compared with three-quarters of the Norwegian material. The registered medical drugs propoxyphene, methadone and ketobemidone accounted for half of the Danish cases. Alcohol and benzodiazepines were present in more than one-third of the cases in both countries.

[Fatal poisonings in Eastern Denmark 1984-1991]

From 1984 to 1991, both years included, 1884 cases of deaths from poisoning by drugs or poisons were found by the forensic chemical analyses at the Institute of Forensic Chemistry in Copenhagen, covering a population of 2.3 million. Most deaths occurred in the age group 30-39 years. Looking at the period as a whole, morphine was by far the most frequently occurring compound followed by propoxyphene, carbon monoxide, methadone and alcohol. However, looking at the annual distribution, the number of deaths due to propoxyphene declines over the period, while the number of deaths due to methadone increases. Barbiturate poisonings, which were formerly among the most frequently occurring, are only seen in low numbers.

[Alcohol and traumatic death in Jalisco]

A review of 4,102 autopsies was carried out during 1989-1991 at the Medical Examiner Office in the state of Jalisco, Mexico, to determine the frequency of high blood alcohol concentration (BAC) in fatal injuries, and the importance of alcohol consumption as a risk factor in homicide. Males showed the highest proportion of positive BAC in every event and age group. BAC > or = 0.001 g/ml was most frequently positive in homicides (56%), followed by unintentional injuries (45%) and suicides (35%). After adjusting for age, sex and year of autopsy, the differences were statistically significant.

Motor-vehicle-related deaths involving intoxicated pedestrians--United States, 1982-1992

Pedestrians account for 14% of all motor-vehicle-related deaths and approximately 3% of all motor-vehicle-related injuries in the United States. In 1992, a total of 5546 pedestrians were killed as a result of motor-vehicle crashes, and 96,000 suffered nonfatal injuries. Because of the effects of alcohol on attention, perception, vision, judgment, and motor control, intoxicated pedestrians are at increased risk for unintentional injury. Although alcohol consumption by pedestrians is an important contributing factor to motor-vehicle crashes in which pedestrians are injured, characteristics of intoxicated pedestrians who are killed as a result of such crashes have not been well defined. This report uses data from the National Highway Traffic Safety Administration's (NHTSA) Fatal Accident Reporting System for 1982-1992 to characterize intoxicated pedestrians aged > 14 years who were killed as a result of motor-vehicle-related crashes.

Injury type, injury severity, and repeat occurrence of alcohol-related trauma in adolescents

Injury associated with alcohol use is a significant problem among adolescents; however, routine evaluation of alcohol use in this population is not conducted. The purpose of this study was to compare injured adolescents presenting to an emergency room with a positive serum alcohol concentration (SAC+) with those injured adolescents with a negative serum alcohol concentration (SAC-). Data were collected retrospectively on 176 injured patients, between the ages of 13 and 18, consecutively admitted to a university hospital from January 1, 1989-December 31, 1990. Information collected included mechanism and severity of injury, outcome, SAC, length of stay, psychiatric history, prior or subsequent admission for injury, and hospital charges. Of those tested with an SAC, more than one-third had a positive SAC. Patients with positive SACs had a greater probability of having a psychiatric history and more frequently had a prior or subsequent injury. Furthermore, only 34% of SAC+ patients were referred for counseling. The results indicate that a SAC should be obtained on all adolescents admitted for trauma, that adolescents presenting with injuries and a positive SAC should be referred for alcohol and psychiatric assessment, and that injured adolescents may be at increased risk for repeat injuries in the future.

Alcohol and casualties: a comparison of emergency room and coroner data

Data from a probability sample of casualty patients treated at a county hospital emergency room (ER) during a 1 year period (N = 1124) are compared to data from coroner reports of all fatalities arising from unnatural causes during the same time period in the same county (N = 304). The two samples are compared on: demographic characteristics, causes of casualty (fall, laceration/puncture wound, motor vehicle, fire, ingestion, other cause), place of injury, and alcohol and drug use prior to the event. Alcohol and drug use data were obtained by breathalyzer and self-reports in the ER sample and by toxicology screening of blood upon autopsy in the coroner sample. The coroner sample was significantly more likely to be male, younger and white compared to the ER sample. A significantly larger proportion of the coroner sample was positive for alcohol (43%) compared to those breathalyzed within 6 hr of injury who reported no drinking after the event (11%) and to those who reported drinking within the 6 hr prior to the event (28%) in the ER sample. Among those who were alcohol positive no difference was found between the coroner sample and the ER sample for the proportion of those who were also drug positive (24% in each). Cases in the coroner sample were no more likely to involve violence (17%) than those in the ER sample (20%). Violence-related fatalities were more likely to involve alcohol (47%) than non-fatal injuries (19%), but were no more likely to involve drug use in combination with alcohol (39% vs. 31%, respectively).

Towards a direct definition of an alcohol-related death: an analysis in Aboriginal adults

This paper addresses the conceptual and methodological difficulties in obtaining reliable information on alcohol-related mortality in Aboriginal communities. A working definition is proposed; this requires an alcohol-positive history together with a consistent mode of death, and is applied retrospectively to a series of 29 adult deaths in a large Aboriginal community. An informant history of alcohol abuse was found to be the most sensitive indicator of an alcohol-positive history and correlated well with autopsy findings and medical records. Alcohol-positive histories were found for 17 of 29 deaths by informant history, for 9 of 29 by autopsy findings, and for 12 of 29 by medical record review. These indicators were combined with a mode of death categorisation to arrive at an estimate of 5 of 29 definite, 5 of 29 probable, and 1 of 29 possible alcohol-related deaths. We conclude by examining the process by which such a definition might be further developed and the context in which resulting information might then be used.

Alcohol involvement in fatal traffic crashes in the United States: 1979-90

Trends in alcohol-related traffic crash fatalities for the United States were examined with data from the Fatal Accident Reporting System for the years 1979-90. Alcohol-related traffic crash fatalities have decreased 10% over the 12 years studied, from 20,245 in 1979 to 18,279 in 1990. Fatality rates per 100 million vehicles miles traveled, and per 100,000 population, registered vehicles and licensed drivers have decreased even more sharply. Rates of blood alcohol testing of fatally injured drivers rose substantially among the States, with the nationwide rate increasing from 44% in 1979 to 75% in 1990. Factors that may be affecting these trends are discussed.

Sedatives and suicide: the San Diego study

Although clinical experience points to the frequent use of sedatives and hypnotics in suicide, remarkably few data are available to characterize the demographics of the population involved. The San Diego study, in which toxicological examinations were performed in over 90% of 204 consecutive suicides seen by the San Diego County Coroner during 1981-1982, provides an opportunity to examine suicide victims who were taking various medicines and drugs of abuse. Drugs were detected in 68% of tested subjects. Anxiolytics and hypnotics were found in 10.7% and 12.3% of the cases respectively. Women were more than 4 times as likely as men to have tested positive for an anxiolytic or hypnotic. Antidepressants were found in 5.9%. Alcohol had been ingested by 28.3% of subjects. Barbiturates and benzodiazepines were found in approximately equal proportions, although nationally the number of barbiturate prescriptions filled in drugstores was only one-sixth that of benzodiazepines. Major depression was found in 22.5%; among cases with positive histories of major depression, only a small proportion ranging from 4-10% were positive for antidepressants, anxiolytics or hypnotics. Interestingly, approximately equal proportions (4.8% and 6.2%) of depressed and non-depressed patients were positive for antidepressants. Among subjects whose deaths were attributed to drug ingestion, benzodiazepines, barbiturates and antidepressants were found in approximately one-third each, with little overlap. Although benzodiazepines were found in less than 10% of the group as a whole, they were found in one-third of subjects who committed suicide by overdose.(ABSTRACT TRUNCATED AT 250 WORDS)

[Causes of death among alcoholics]

During the five year period 1987-91, 377 deaths among alcoholics were examined at the Gade Institute, Department of Forensic Medicine, University of Bergen. The material was dominated by male alcoholics. More than half the cases were regarded as natural deaths. Among these, the dominating cause of death was cardiovascular disease. The rest of the material, where death was attributed to non-natural causes, was dominated by lethal intoxications. A large number of the deaths were suicides.

Alcohol's effect on fatality risk from a physical insult

Although alcohol's effect on the risk of being involved in a traffic crash is well known, its influence on the risk of death, given that a crash has occurred, is more uncertain. One study published a few years ago finds that alcohol increases such risk. The present study examines alcohol's effect on fatality risk in a crash using data and methods independent of the previous study, and provides estimates as a function of blood alcohol concentration (BAC). Data for drivers with measured BAC who were fatally injured in a two-car crash were selected from the Fatal Accident Reporting System (FARS). The study uses two sets of fatal crashes. For one, the probability that a BAC = 0 driver was killed is low, so that if alcohol increased fatality risk, this would generate additional fatalities at higher BAC levels. For the other set of crashes, fatality risk was sufficiently close to 100% that other factors had little opportunity to influence it. Dividing the fatalities that can be affected by alcohol by those that cannot measures alcohol's influence on fatality risk, and gives that a driver with BAC = 0.1% is 1.9 +/- 0.2 times as likely as is a BAC = 0 driver to be killed in the same crash. The corresponding ratio for a BAC = 0.25% driver is 3.3 +/- 0.5. While derived using the "laboratory" of traffic, there does not appear to be any obvious reason why the results should not apply to physical trauma in general, so a BAC of 0.1% doubles the risk of death from a given impact, and a BAC of 0.25% triples the risk.

The prevalence of alcohol-related mortality in both sexes: variation between indicators, Stockholm, 1987

OBJECTIVES

The purpose of this study was to analyze the prevalence rates of alcohol-related mortality--according to various indicators--in both sexes in Stockholm, Sweden.

METHODS

A study of alcohol involvement at death was undertaken for all 668 deceased persons aged 15 through 54 years in 1987 in Stockholm. Death certificates, autopsy information, police records, and information about earlier conviction were analyzed.

RESULTS

When different measures of estimation were compared, there were great differences in the prevalence rates of alcohol involvement. According to the death certificates, 9.2% of the males and 11.2% of the females had alcoholism, alcohol intoxication, pancreatitis or liver cirrhosis as underlying cause of death. When all accessible information was used, potential alcohol involvement was found in 57.5% of the male and in 32.2% of the female deaths. There was a marked association between earlier drunken driving and alcohol involvement. After reevaluation of the diagnoses with autopsy findings, the number of cases with cardiac enlargement and suspected cardiomyopathy increased from 10 to 62.

CONCLUSION

The results point to the serious underdiagnosis of alcohol involvement in death certificates and the misclassification of important causes of death (i.e., liver cirrhosis and cardiac disease); they also call for increased efforts regarding prevention.

Mortality in alcohol-related diseases in Sweden during 1971-80 in relation to occupation, marital status and citizenship in 1970

A new Swedish population register, created by linking Census data to the Cause of Death Registry and covering over 99% of the population, has been used to study the relationship between occupational category, marital status and citizenship in 1970 and mortality in closely alcohol-related diseases during 1971-1980 for the ages 25-64 years. Age-standardized rate ratios (SRR) have been computed for mortality in alcoholism, alcohol intoxication and alcohol psychosis ("AAA") and in liver cirrhosis. SRR-values for both diagnose categories and both sexes were higher than average among not gainfully employed (SRR = 3.71 among males and SRR = 1.96 among females in 1976-80 for "AAA"), among employees in the service sector, engine-drivers and unskilled workers and increased in liver cirrhosis among artists and authors. Among females there were smaller variations in mortality for occupational groups than among males. The SRR-values showed a tendency to be higher in 1976-80 than in 1971-75, probably due to health-related selection to some extent. The alcohol-related mortality was also increased among divorced, widows (SRR = 1.37 for "AAA" and 2.81 for liver cirrhosis in 1976-80) and widowers and among never married males. SRR was much higher among Finnish citizens in Sweden (SRR for "AAA" = 3.85 among males and 2.35 among females in 1976-80) than among males and females living in Finland (SRR for "AAA" = 1.13 among males and 0.36 among females) and also higher than among immigrants from other countries, summed (SRR for "AAA" = 0.62 among males and 0.64 among females).(ABSTRACT TRUNCATED AT 250 WORDS)

Motor vehicle fatalities in Rhode Island (FY1990-1991): a report on driver impairment

Autopsy specimens from 52 fatally injured drivers in Rhode Island were analyzed for the presence of alcohol and other drugs of abuse, including, among others, cocaine, opiates, cannabinoids (THC), and phencyclidine (PCP). The ages of the drivers ranged from 16 to 87 years; 41 were male and 11 female. Based on this sample, 65% of Rhode Island driver fatalities involve drugs. The most common drug, alcohol was found in 59% of the cases. Drugs other than alcohol were detected in 19% of the cases, 13% had illicit drugs found in combination with alcohol, and 6% had illicit drugs only.

Alcohol and deaths in police custody

We examined the involvement of alcohol consumption, chronic alcohol abuse or dependence, the soundness of the police determination of alcohol-related intoxication, and the importance of other drugs in deaths in police custody in a survey of the cases reported to the Chief Coroner of Ontario during the past 10 years. The data suggest no mismanagement by the police. At least 86% of the fatalities were associated with recent alcohol consumption or chronic alcohol abuse/dependence. Use of drugs other than alcohol was far less common. Promoting use and further development of simple tests to estimate blood alcohol concentration, chronic alcohol problems, and suicide risk, before incarceration takes place, may save lives.

[Effect of alcohol as a cause of fatal traffic accidents: are official figures correct?]

Starting point is the question whether in the official records of fatal road accidents driving while intoxicated is adequately taken into account as a cause. A former investigation with accident data of 1976 yielded a considerable number of undetected and not registered cases. On the basis of the fatal road accidents of the Saarland region for the years 1988, 1989 and 1990 the former results could be confirmed on the whole. Only with 25 per cent of all persons involved in a fatal accident a breath or blood test for checking alcoholic impairment had been arranged. The assumption is well substantiated that the remaining 75 per cent include many impaired persons and that not only every fifth victim of traffic accidents is a result of alcoholic impairment but about 40 per cent. Proposals are made for getting in the future more reliable counts and a better basis for fighting against DWI-offences.

Driver fatalities and DUI offenders in New Jersey

Comparisons of driving and demographic characteristics were made on 407 driver fatalities (DFs) and 407 motorists convicted of driving under the influence (DUI). Significantly more DUI offenders (DOs) than DFs were men and had previous DUIs, accidents, license suspensions, and weekend "index" events. DFs with a blood or brain alcohol concentration (BAC) of 100 or above mg/dL matched most closely with DOs on negative driving events, "index" event days, and demographics. Conversely, DFs with negative BACs differed significantly with DOs on virtually all characteristics. High-BAC DFs and DOs may well be drawn from the same subpopulation of deviant drivers, whereas DFs with negative BACs seem similar to licensed drivers in general.

[Prevalence of alcohol in fatalities in forensic medicine]

Blood alcohol tests were carried out at the Institute of Forensic Medicine of the University of Hamburg in 1,000 sudden unexpected natural deaths and non-natural deaths (590 males, 410 females) during the first six months of 1989. In 18.6% of the cases (142 males, 44 females) a blood alcohol concentration of more than 0.1% was found. The blood alcohol concentration ranged from 0.1 to 1% in 87 cases; in 99 cases the blood alcohol concentration exceeded 1%; there were 17 fatalities with more than 3%. More than 95% of blood alcohol concentration values exceeding 2.5% were found in the age group of 40-69 years. As expected positive blood alcohol estimations and especially high blood alcohol concentrations were found in non-natural deaths. However, many cases with relevant blood alcohol findings had been classified as "sudden natural death" and were not investigated by autopsy. In 74 cases alcohol blood tests were ordered by the police.

Alcohol-related mortality in the United States, 1979-1988

Using alcohol-attributable fractions derived from studies of alcohol's involvement in various causes of death, this report presents trends in overall alcohol-related mortality for each year from 1979 through 1988. Age-adjusted rates show decreases in alcohol-related mortality for both sexes and for whites and nonwhites. Decreases occur for causes of death directly attributable to alcohol and for other diseases and injuries and adverse effects indirectly attributable to alcohol. Issues surrounding the use of currently available alcohol-attributable fractions for estimating alcohol-related mortality are discussed.

Wellington coroner autopsy cases 1970-89: acute deaths due to drugs, alcohol and poisons

Coronal autopsy reports attributing deaths to drugs or poisonings were examined for the period 1970-89. There were 239 deaths of which 69% were suicide, 23% were accidental, 4% therapeutic misadventure, and 4% of uncertain category. 10.4% of deaths were due solely to alcohol and alcohol was found in another 13% of deaths from other drugs and poisons [corrected]. Twenty-seven percent of deaths were attributed to carbon monoxide poisoning. Five percent of deaths were due to poisons. Prescription drugs were the cause of deaths in 54% with the principle drug classes being opioids (14%), tricyclic antidepressants (12%), barbiturates (11%), hypnosedatives (8%). Prescribers need to be aware of the interactions of such drugs with alcohol, and to consider safer alternative drugs for those at risk of overdose or drug misuse.

[Fatalities in alcoholic intoxication in the aged]

In 1989, the blood-alcohol-concentration of 1545 elderly persons with an age of at least 60 years, who died suddenly or not of natural causes, was determined at the Institute for Legal Medicine in Hamburg. 238 autopsies were performed. In a total of 143, in 55 subjects of the autopsy series, a blood-alcohol-concentration over 0.05% was found. With growing age the number of positive blood-alcohol-analyses decreased. Twenty-two of the autopsied persons (40%) did not die of natural causes; among them were 11 accidents. Alcohol played a significant role in the fatal course of 8 cases; 15 subjects included in the autopsy series (27.3%) had been alcoholics. Preexisting cardiovascular and respiratory disease was diagnosed in most cases of natural death. The causal connection of alcohol, disease, and cause of death in the elderly is discussed.

[Diagnosis of "fatal ethanol poisoning in the absorption phase"]

In cases of disputed fatal alcohol intoxication during the absorption (pre-peak) period it is strongly recommended to examine the blood ethanol level not only in blood taken from a peripheral vessel but also simultaneously in blood from at least one central. In the case reported, without such a duplex determination of the blood ethanol concentration it would have been impossible to establish the actual cause of death.

Alcohol-related relative risk of fatal driver injuries in relation to driver age and sex

The relative risks of fatal crash involvement at various blood alcohol concentrations (BACs) were examined using data on fatal driver injuries from the Fatal Accident Reporting System in conjunction with driver exposure data from the second national road-side breath-testing survey. Based on driver fatalities in single-vehicle crashes, it was estimated that each 0.02 percentage increase in the BAC of a driver with non-zero BAC nearly doubles the risk of being in a fatal crash. Crash risk was found to increase with increasing BAC among all of the six age and sex groups studied. At BACs in the 0.05-0.09 percent range, the likelihood of a crash was at least nine times greater than at zero BAC for all age groups. Younger drivers with BACs in the 0.05-0.09 range had higher relative risks than older drivers, and females had higher relative risks than males. At very high BACs (at or above 0.15 percent), the risk of crashing was 300 to 600 times the risk at zero or near-zero BACs. These relative risk estimates are considerably higher than estimated in other studies, but other studies have based their estimates on all crashes rather than single-vehicle crashes only. In this study, relative risks were also lower when based on driver fatalities in all crashes. However, when plausible assumptions were made about the BAC distributions of other participants in multiple-vehicle crashes (whose actual BAC is often unknown), the relative risks based on the maximum BAC of the crash participants were nearly as high as those estimated in single-vehicle crashes.

[The morphological equivalents of the peripheral nervous system reaction in certain types of death]

The article deals with the results of analysis of morphological changes in peripheral nervous system in some types of violent and sudden death. They reflect characteristics of morpho- and pathogenesis and can be used to validate the main cause of death.

Alcohol and fatal injuries in Oklahoma

To assess the usefulness of medical examiner data in describing the relationship between alcohol use and fatal injuries, 1978-84 data from the Office of the Chief Medical Examiner (ME), State of Oklahoma, was examined. In each year in the study period, approximately 1,500 deaths resulted from unintentional injuries (UI) and 800 deaths resulted from intentional injuries (i.e., suicides and homicides). For persons who died on the same day they were injured, testing for blood alcohol ranged from 90% of homicide victims, to 73% of suicide victims and to 66% of UI victims. Alcohol was associated with 52% of homicides, 49% of UI and 40% of suicides. Alcohol was detected most often in samples from Hispanic men and from Native Americans of both sexes. This study suggests that state public health agencies and researchers should consider the use of ME data for epidemiologic information on the relationship between alcohol and injury-related mortality and for surveillance of these problems.

[Diagnosis of myocardial infarct with fatal outcome within the framework of multifactorial prevention of ischemic heart disease in Moscow]

The death diagnosis of myocardial infarction (including acute heart failure) was recorded and verified on the basis of standard criteria during a 5-year implementation of the Program on Multifactorial Prevention of Coronary Heart Disease among males aged 40-59 years. The analysis demonstrated that the hyperdiagnosis of acute heart failure as a death cause was observed in 29.0% of cases, death being due to acute alcohol intoxication in 43% of all the inconsistent diagnoses.