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Pierre Charbonneau - One of the best experts on this subject based on the ideXlab platform.
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a comparison of survival with and without extracorporeal life support treatment for severe poisoning due to Drug Intoxication
Resuscitation, 2012Co-Authors: Romain Masson, Philippe Lehoux, Pierre Charbonneau, Massimo Massetti, Vincent Colas, Jeanjacques Parienti, F Saulnier, Cedric DaubinAbstract:Abstract Background The use of extracorporeal life support (ECLS) as a treatment for severe cardiovascular impairment due to poisoning is unclear. Therefore, we conducted a retrospective cohort analysis to compare survival among critically ill poisoned patients treated with or without ECLS. Methods All consecutive patients admitted into 2 university hospitals in northwestern France over the past decade for persistent cardiac arrest or severe shock following poisoning due to Drug Intoxication were included. ECLS was preferentially performed in 1 of the 2 centers. Results Sixty-two patients (39 women, 23 men; mean age 48±17 years) fulfilled inclusion criteria: 10 with persistent cardiac arrest and 42 with severe shock. Fourteen patients were treated with ECLS and 48 patients with conventional therapies. All subjects received vasopressor and fluid loading. Patients treated with or without ECLS at ICU admission had comparable Drug ingestion histories, Simplified Acute Physiology Score (SAPS II score) (66±18), Sequential Organ Failure Assessment (SOFA) score (median: 11 [IQR, 9–13]), Glasgow Coma Scale score (median: 3 [IQR, 3–11]), need for ventilator support ( n =56) and extra renal support ( n =23). Thirty-five (56%) patients survived: 12/14 (86%) ECLS patients and 23/48 (48%) non-ECLS patients ( p =0.02, by Fisher exact test). None of the patients with persistent cardiac arrest survived without ECLS support. Based on admission data, beta-blocker Intoxication ( p =0.02) was also associated with lower mortality. In multivariate analysis, adjusting for SAPS II and beta-blocker Intoxication, ECLS support remained associated with lower mortality [Adjusted Odds Ratio, 0.18; 95% CI, 0.03–0.96; p =0.04]. Conclusion In the absence of response to conventional therapies, we consider that ECLS may improve survival in critically ill poisoned patients experiencing cardiac arrest and severe shock.
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extracorporeal life support in severe Drug Intoxication a retrospective cohort study of seventeen cases
Critical Care, 2009Co-Authors: Cedric Daubin, Charlotte Quentin, Philippe Lehoux, Olivier Lepage, Calin Ivascau, Marine Tasle, Mehdi Bousta, Massimo Massetti, Pierre CharbonneauAbstract:Cardiovascular failure is the leading cause of death in severe acute Drug Intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a Drug overdose. This is a retrospective cohort study of 17 patients admitted over a 10-year period for prolonged cardiac arrest or refractory shock following a Drug overdose and not responding to optimal conventional treatment. Patients were evaluated in the medical ICU and cardiovascular surgery department of a university hospital. ECLS implantation used a centrifugal pump connected to a hollow-fiber membrane oxygenator and was performed in the operating room (n = 13), intensive care unit (n = 3), or emergency department (n = 1). ECLS was employed for refractory shock and prolonged cardiac arrest in 10 and 7 cases, respectively. The mean duration of external cardiac massage was 101 ± 55 minutes. Fifteen patients had ingested cardiotoxic Drugs, including 11 cases of Drugs with membrane stabilizing activity. Time from hospital admission to initiation of ECLS was 6.4 ± 7.0 hours. Time to ECLS implant was 58 ± 11 minutes. The mean ECLS flow rate was 3.45 ± 0.45 L/min. The average ECLS duration was 4.5 ± 2.4 days. Early complications included limb ischemia (n = 6), femoral thrombus (n = 1), cava inferior thrombus (n = 1), and severe bleeding at the site of cannulation (n = 2). Fifteen patients were weaned off ECLS support and 13 (76%) were discharged to hospital without sequelae. Based on our experience, we consider ECLS as a last resort, efficient, and relatively safe therapeutic option in this population. However, the uncontrolled nature of our data requires careful interpretation.
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extracorporeal life support in severe Drug Intoxication a retrospective cohort study of seventeen cases
Critical Care, 2009Co-Authors: Cedric Daubin, Charlotte Quentin, Philippe Lehoux, Olivier Lepage, Calin Ivascau, Marine Tasle, Mehdi Bousta, Massimo Massetti, Pierre CharbonneauAbstract:Introduction Cardiovascular failure is the leading cause of death in severe acute Drug Intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a Drug overdose.
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refractory shock and asystole related to tramadol overdose
Clinical Toxicology, 2007Co-Authors: Cedric Daubin, Charlotte Quentin, Jeanpierre Goulle, Damien Guillotin, Philippe Lehoux, Olivier Lepage, Pierre CharbonneauAbstract:Introduction. Tramadol use is largely considered safe. However, several lethal cases of tramadol Intoxication were reported, suggesting an underestimated toxicity. We report for a tramadol overdose case in combination with other central nervous system depressants, leading to refractory shock requiring extracorporeal life support. Case report. A 33-year-old man was admitted in our intensive care unit for Drug Intoxication with coma, seizures, and hypotension without signs of heart failure. A few hours later, he developed a ventricular tachycardia, followed by a brief cardiac arrest in asystole with refractory shock requiring an extracorporeal life support, vasopressors, and hemofiltration. With this aggressive support, his overall status gradually improved. Repeated echocardiography showed an improvement in the cardiac function. The patient was weaned off extracorporeal life support on day eight and discharged on day 12. On admission, a urine analysis, using gas chromatography-mass spectrometry, showed hig...
Ian R H Rockett - One of the best experts on this subject based on the ideXlab platform.
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method overtness forensic autopsy and the evidentiary suicide note a multilevel national violent death reporting system analysis
PLOS ONE, 2018Co-Authors: Ian R H Rockett, Eric D Caine, Hilary S Connery, Christa L Lilly, Kurt B. Nolte, Ted R Miller, Steven Stack, Lewis S NelsonAbstract:Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by Drug-Intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. Methods This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011–2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. Results An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among Drug Intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Conclusions Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of Drug Intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.
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discerning suicide in Drug Intoxication deaths paucity and primacy of suicide notes and psychiatric history
PLOS ONE, 2018Co-Authors: Ian R H Rockett, Eric D Caine, Hilary S Connery, Gail Donofrio, David Gunnell, Nestor D Kapusta, Mark S. Kaplan, Kurt B. Nolte, Ted R Miller, Christa L LillyAbstract:Objective A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of Drug Intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by Drug Intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods. Methods This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011–2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. Results A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among Drug Intoxication cases than gunshot/hanging cases. The latter were more likely than Intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43–49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11–44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11–2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10–1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for Intoxication cases (OR, 45.43; 95% CI, 31.06–66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19–3.18) and depression (OR, 1.48; 95% CI, 1.17–1.87) were associated with suicide classification in Intoxication but not gunshot/hanging cases. Conclusions Without psychological/psychiatric evidence contributing to manner of death classification, suicide by Drug Intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and Drug deaths.
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deciphering suicide and other manners of death associated with Drug Intoxication a centers for disease control and prevention consultation meeting summary
American Journal of Public Health, 2017Co-Authors: Deborah M Stone, Kristin M Holland, Brad Bartholow, Joseph E Logan, Wendy Likamwa Mcintosh, Aimee Trudeau, Ian R H RockettAbstract:Manner of death (MOD) classification (i.e., natural, accident, suicide, homicide, or undetermined cause) affects mortality surveillance and public health research, policy, and practice. Determination of MOD in deaths caused by Drug Intoxication is challenging, with marked variability across states.The Centers for Disease Control and Prevention hosted a multidisciplinary meeting to discuss Drug Intoxication deaths as they relate to suicide and other MOD. The meeting objectives were to identify individual-level, system-level, and place-based factors affecting MOD classification and identify potential solutions to classification barriers.Suggested strategies included improved standardization in death scene investigation, toxicology, and autopsy practice; greater accountability; and creation of job aids for investigators. Continued collaboration and coordination of activities are needed among stakeholders to affect prevention efforts.
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variable classification of Drug Intoxication suicides across us states a partial artifact of forensics
PLOS ONE, 2015Co-Authors: Ian R H Rockett, Kurt B. Nolte, Gerald R Hobbs, Haomiao Jia, Gordon S Smith, Sandra L Putnam, Eric D CaineAbstract:BACKGROUND: The 21st-century epidemic of pharmaceutical and other Drug-Intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-Intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. OBJECTIVE: To evaluate whether observed variation in the relative magnitude of Drug-Intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. METHODS: This was a national, state-based, ecological study of 111,583 Drug-Intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) Drug-Intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific Drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files. RESULTS: Across states, the proportion of Drug-Intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined Drug-Intoxication death rates and corresponding suicide rates (Spearman's rho = 0.38; pCONCLUSION: Large interstate variation in the relative magnitude of nonhomicide Drug-Intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of Drug-induced suicides and other Drug-Intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment. Language: en
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58 medical examiner coroner systems and state variability in reporting suicide and unintentional Drug Intoxication deaths distorting reality and impeding prevention
Injury Prevention, 2015Co-Authors: Ian R H Rockett, Kurt B. Nolte, Gerald R Hobbs, Dan Wu Zhejiang, Haomiao Jia, Gordon S Smith, Eric D CaineAbstract:Statement of purpose The 21st-century surge in national Drug-Intoxication deaths has been associated with a growing problem of suicide misclassification. Prevention of suicide and lethal Drug Intoxications depends upon accurate classification of manner of death. This study evaluated interstate variation in reporting Drug-Intoxication suicides and their potential misclassification according to type of medicolegal death investigation system. Methods/approach An observational mortality study of all 111,583 Drug-Intoxication decedents from the 50 states for the period 2008–2010, whose manner of death was suicide, accident, or undetermined intent. Data derived from CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS). The main outcome measure was the rate ratio of combined accident plus undetermined intent to suicide Drug-Intoxication deaths (indexing potential suicide misclassification), and percentage of Intoxication deaths specifying at least one Drug (indexing fastidiousness of the death investigation process). Results Drug-Intoxication suicide rates ranged from a high of 3.68 deaths per 100,000 persons in New Mexico to 0.65 per 100,000 in North Dakota. The rate ratio of combined accident and undetermined intent to suicide Drug-Intoxication deaths ranged from 16.11 in Louisiana (Drug-Intoxication suicide rate = 0.79 per 100,000) to 2.49 in South Dakota (Drug-Intoxication suicide rate = 1.74 per 100,000). Adjusting for Drug-specification, states with a decentralised coroner system were 46 times more likely to have a high rate ratio (>7.00) of the combined accident plus undetermined intent to suicide Drug-Intoxication deaths as states with a centralised medical examiner system (95% CI, 3.14–1750.22). Conclusions Results suggest that the numerous jurisdictions not meeting rigorous standards for conducting medicolegal death investigations are excessively prone to differentially undercounting Drug-Intoxication suicides. Significance and contributions There is a national urgency to have uniform state and local death investigation and reporting systems that meet high standards in ascertaining manner of death and providing appropriate surveillance data for evidence-based interventions.
Cedric Daubin - One of the best experts on this subject based on the ideXlab platform.
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a comparison of survival with and without extracorporeal life support treatment for severe poisoning due to Drug Intoxication
Resuscitation, 2012Co-Authors: Romain Masson, Philippe Lehoux, Pierre Charbonneau, Massimo Massetti, Vincent Colas, Jeanjacques Parienti, F Saulnier, Cedric DaubinAbstract:Abstract Background The use of extracorporeal life support (ECLS) as a treatment for severe cardiovascular impairment due to poisoning is unclear. Therefore, we conducted a retrospective cohort analysis to compare survival among critically ill poisoned patients treated with or without ECLS. Methods All consecutive patients admitted into 2 university hospitals in northwestern France over the past decade for persistent cardiac arrest or severe shock following poisoning due to Drug Intoxication were included. ECLS was preferentially performed in 1 of the 2 centers. Results Sixty-two patients (39 women, 23 men; mean age 48±17 years) fulfilled inclusion criteria: 10 with persistent cardiac arrest and 42 with severe shock. Fourteen patients were treated with ECLS and 48 patients with conventional therapies. All subjects received vasopressor and fluid loading. Patients treated with or without ECLS at ICU admission had comparable Drug ingestion histories, Simplified Acute Physiology Score (SAPS II score) (66±18), Sequential Organ Failure Assessment (SOFA) score (median: 11 [IQR, 9–13]), Glasgow Coma Scale score (median: 3 [IQR, 3–11]), need for ventilator support ( n =56) and extra renal support ( n =23). Thirty-five (56%) patients survived: 12/14 (86%) ECLS patients and 23/48 (48%) non-ECLS patients ( p =0.02, by Fisher exact test). None of the patients with persistent cardiac arrest survived without ECLS support. Based on admission data, beta-blocker Intoxication ( p =0.02) was also associated with lower mortality. In multivariate analysis, adjusting for SAPS II and beta-blocker Intoxication, ECLS support remained associated with lower mortality [Adjusted Odds Ratio, 0.18; 95% CI, 0.03–0.96; p =0.04]. Conclusion In the absence of response to conventional therapies, we consider that ECLS may improve survival in critically ill poisoned patients experiencing cardiac arrest and severe shock.
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extracorporeal life support in severe Drug Intoxication a retrospective cohort study of seventeen cases
Critical Care, 2009Co-Authors: Cedric Daubin, Charlotte Quentin, Philippe Lehoux, Olivier Lepage, Calin Ivascau, Marine Tasle, Mehdi Bousta, Massimo Massetti, Pierre CharbonneauAbstract:Cardiovascular failure is the leading cause of death in severe acute Drug Intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a Drug overdose. This is a retrospective cohort study of 17 patients admitted over a 10-year period for prolonged cardiac arrest or refractory shock following a Drug overdose and not responding to optimal conventional treatment. Patients were evaluated in the medical ICU and cardiovascular surgery department of a university hospital. ECLS implantation used a centrifugal pump connected to a hollow-fiber membrane oxygenator and was performed in the operating room (n = 13), intensive care unit (n = 3), or emergency department (n = 1). ECLS was employed for refractory shock and prolonged cardiac arrest in 10 and 7 cases, respectively. The mean duration of external cardiac massage was 101 ± 55 minutes. Fifteen patients had ingested cardiotoxic Drugs, including 11 cases of Drugs with membrane stabilizing activity. Time from hospital admission to initiation of ECLS was 6.4 ± 7.0 hours. Time to ECLS implant was 58 ± 11 minutes. The mean ECLS flow rate was 3.45 ± 0.45 L/min. The average ECLS duration was 4.5 ± 2.4 days. Early complications included limb ischemia (n = 6), femoral thrombus (n = 1), cava inferior thrombus (n = 1), and severe bleeding at the site of cannulation (n = 2). Fifteen patients were weaned off ECLS support and 13 (76%) were discharged to hospital without sequelae. Based on our experience, we consider ECLS as a last resort, efficient, and relatively safe therapeutic option in this population. However, the uncontrolled nature of our data requires careful interpretation.
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extracorporeal life support in severe Drug Intoxication a retrospective cohort study of seventeen cases
Critical Care, 2009Co-Authors: Cedric Daubin, Charlotte Quentin, Philippe Lehoux, Olivier Lepage, Calin Ivascau, Marine Tasle, Mehdi Bousta, Massimo Massetti, Pierre CharbonneauAbstract:Introduction Cardiovascular failure is the leading cause of death in severe acute Drug Intoxication. In this setting, we report the feasibility, complications, and outcome of emergency extracorporeal life support (ECLS) in refractory shock or cardiac arrest following a Drug overdose.
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refractory shock and asystole related to tramadol overdose
Clinical Toxicology, 2007Co-Authors: Cedric Daubin, Charlotte Quentin, Jeanpierre Goulle, Damien Guillotin, Philippe Lehoux, Olivier Lepage, Pierre CharbonneauAbstract:Introduction. Tramadol use is largely considered safe. However, several lethal cases of tramadol Intoxication were reported, suggesting an underestimated toxicity. We report for a tramadol overdose case in combination with other central nervous system depressants, leading to refractory shock requiring extracorporeal life support. Case report. A 33-year-old man was admitted in our intensive care unit for Drug Intoxication with coma, seizures, and hypotension without signs of heart failure. A few hours later, he developed a ventricular tachycardia, followed by a brief cardiac arrest in asystole with refractory shock requiring an extracorporeal life support, vasopressors, and hemofiltration. With this aggressive support, his overall status gradually improved. Repeated echocardiography showed an improvement in the cardiac function. The patient was weaned off extracorporeal life support on day eight and discharged on day 12. On admission, a urine analysis, using gas chromatography-mass spectrometry, showed hig...
Eric D Caine - One of the best experts on this subject based on the ideXlab platform.
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method overtness forensic autopsy and the evidentiary suicide note a multilevel national violent death reporting system analysis
PLOS ONE, 2018Co-Authors: Ian R H Rockett, Eric D Caine, Hilary S Connery, Christa L Lilly, Kurt B. Nolte, Ted R Miller, Steven Stack, Lewis S NelsonAbstract:Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by Drug-Intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. Methods This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011–2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. Results An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among Drug Intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Conclusions Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of Drug Intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.
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discerning suicide in Drug Intoxication deaths paucity and primacy of suicide notes and psychiatric history
PLOS ONE, 2018Co-Authors: Ian R H Rockett, Eric D Caine, Hilary S Connery, Gail Donofrio, David Gunnell, Nestor D Kapusta, Mark S. Kaplan, Kurt B. Nolte, Ted R Miller, Christa L LillyAbstract:Objective A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of Drug Intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by Drug Intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods. Methods This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011–2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. Results A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among Drug Intoxication cases than gunshot/hanging cases. The latter were more likely than Intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43–49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11–44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11–2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10–1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for Intoxication cases (OR, 45.43; 95% CI, 31.06–66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19–3.18) and depression (OR, 1.48; 95% CI, 1.17–1.87) were associated with suicide classification in Intoxication but not gunshot/hanging cases. Conclusions Without psychological/psychiatric evidence contributing to manner of death classification, suicide by Drug Intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and Drug deaths.
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variable classification of Drug Intoxication suicides across us states a partial artifact of forensics
PLOS ONE, 2015Co-Authors: Ian R H Rockett, Kurt B. Nolte, Gerald R Hobbs, Haomiao Jia, Gordon S Smith, Sandra L Putnam, Eric D CaineAbstract:BACKGROUND: The 21st-century epidemic of pharmaceutical and other Drug-Intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-Intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. OBJECTIVE: To evaluate whether observed variation in the relative magnitude of Drug-Intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. METHODS: This was a national, state-based, ecological study of 111,583 Drug-Intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) Drug-Intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific Drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files. RESULTS: Across states, the proportion of Drug-Intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined Drug-Intoxication death rates and corresponding suicide rates (Spearman's rho = 0.38; pCONCLUSION: Large interstate variation in the relative magnitude of nonhomicide Drug-Intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of Drug-induced suicides and other Drug-Intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment. Language: en
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58 medical examiner coroner systems and state variability in reporting suicide and unintentional Drug Intoxication deaths distorting reality and impeding prevention
Injury Prevention, 2015Co-Authors: Ian R H Rockett, Kurt B. Nolte, Gerald R Hobbs, Dan Wu Zhejiang, Haomiao Jia, Gordon S Smith, Eric D CaineAbstract:Statement of purpose The 21st-century surge in national Drug-Intoxication deaths has been associated with a growing problem of suicide misclassification. Prevention of suicide and lethal Drug Intoxications depends upon accurate classification of manner of death. This study evaluated interstate variation in reporting Drug-Intoxication suicides and their potential misclassification according to type of medicolegal death investigation system. Methods/approach An observational mortality study of all 111,583 Drug-Intoxication decedents from the 50 states for the period 2008–2010, whose manner of death was suicide, accident, or undetermined intent. Data derived from CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS). The main outcome measure was the rate ratio of combined accident plus undetermined intent to suicide Drug-Intoxication deaths (indexing potential suicide misclassification), and percentage of Intoxication deaths specifying at least one Drug (indexing fastidiousness of the death investigation process). Results Drug-Intoxication suicide rates ranged from a high of 3.68 deaths per 100,000 persons in New Mexico to 0.65 per 100,000 in North Dakota. The rate ratio of combined accident and undetermined intent to suicide Drug-Intoxication deaths ranged from 16.11 in Louisiana (Drug-Intoxication suicide rate = 0.79 per 100,000) to 2.49 in South Dakota (Drug-Intoxication suicide rate = 1.74 per 100,000). Adjusting for Drug-specification, states with a decentralised coroner system were 46 times more likely to have a high rate ratio (>7.00) of the combined accident plus undetermined intent to suicide Drug-Intoxication deaths as states with a centralised medical examiner system (95% CI, 3.14–1750.22). Conclusions Results suggest that the numerous jurisdictions not meeting rigorous standards for conducting medicolegal death investigations are excessively prone to differentially undercounting Drug-Intoxication suicides. Significance and contributions There is a national urgency to have uniform state and local death investigation and reporting systems that meet high standards in ascertaining manner of death and providing appropriate surveillance data for evidence-based interventions.
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confronting death from Drug self Intoxication ddsi prevention through a better definition
American Journal of Public Health, 2014Co-Authors: Ian R H Rockett, Eric D Caine, Nestor D Kapusta, Kurt B. Nolte, Ted R Miller, Gordon S Smith, Randy Hanzlick, Luke G Larkin, Charles P E Naylor, Sandra L PutnamAbstract:Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many Drug Intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit Drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-Intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from Drug self-Intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of Drug Intoxication fatalities.
Kurt B. Nolte - One of the best experts on this subject based on the ideXlab platform.
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method overtness forensic autopsy and the evidentiary suicide note a multilevel national violent death reporting system analysis
PLOS ONE, 2018Co-Authors: Ian R H Rockett, Eric D Caine, Hilary S Connery, Christa L Lilly, Kurt B. Nolte, Ted R Miller, Steven Stack, Lewis S NelsonAbstract:Objective Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by Drug-Intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. Methods This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011–2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. Results An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among Drug Intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Conclusions Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of Drug Intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.
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discerning suicide in Drug Intoxication deaths paucity and primacy of suicide notes and psychiatric history
PLOS ONE, 2018Co-Authors: Ian R H Rockett, Eric D Caine, Hilary S Connery, Gail Donofrio, David Gunnell, Nestor D Kapusta, Mark S. Kaplan, Kurt B. Nolte, Ted R Miller, Christa L LillyAbstract:Objective A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of Drug Intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by Drug Intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods. Methods This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011–2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. Results A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among Drug Intoxication cases than gunshot/hanging cases. The latter were more likely than Intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43–49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11–44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11–2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10–1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for Intoxication cases (OR, 45.43; 95% CI, 31.06–66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19–3.18) and depression (OR, 1.48; 95% CI, 1.17–1.87) were associated with suicide classification in Intoxication but not gunshot/hanging cases. Conclusions Without psychological/psychiatric evidence contributing to manner of death classification, suicide by Drug Intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and Drug deaths.
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variable classification of Drug Intoxication suicides across us states a partial artifact of forensics
PLOS ONE, 2015Co-Authors: Ian R H Rockett, Kurt B. Nolte, Gerald R Hobbs, Haomiao Jia, Gordon S Smith, Sandra L Putnam, Eric D CaineAbstract:BACKGROUND: The 21st-century epidemic of pharmaceutical and other Drug-Intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-Intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice. OBJECTIVE: To evaluate whether observed variation in the relative magnitude of Drug-Intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system. METHODS: This was a national, state-based, ecological study of 111,583 Drug-Intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) Drug-Intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific Drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files. RESULTS: Across states, the proportion of Drug-Intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined Drug-Intoxication death rates and corresponding suicide rates (Spearman's rho = 0.38; pCONCLUSION: Large interstate variation in the relative magnitude of nonhomicide Drug-Intoxication deaths classified as suicide by medical examiners and coroners in the US appears partially an artifact of geographic region and degree of toxicological assessment in the case ascertainment process. Etiologic understanding and prevention of Drug-induced suicides and other Drug-Intoxication deaths first require rigorous standardization involving accurate concepts, definitions, and case ascertainment. Language: en
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58 medical examiner coroner systems and state variability in reporting suicide and unintentional Drug Intoxication deaths distorting reality and impeding prevention
Injury Prevention, 2015Co-Authors: Ian R H Rockett, Kurt B. Nolte, Gerald R Hobbs, Dan Wu Zhejiang, Haomiao Jia, Gordon S Smith, Eric D CaineAbstract:Statement of purpose The 21st-century surge in national Drug-Intoxication deaths has been associated with a growing problem of suicide misclassification. Prevention of suicide and lethal Drug Intoxications depends upon accurate classification of manner of death. This study evaluated interstate variation in reporting Drug-Intoxication suicides and their potential misclassification according to type of medicolegal death investigation system. Methods/approach An observational mortality study of all 111,583 Drug-Intoxication decedents from the 50 states for the period 2008–2010, whose manner of death was suicide, accident, or undetermined intent. Data derived from CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS). The main outcome measure was the rate ratio of combined accident plus undetermined intent to suicide Drug-Intoxication deaths (indexing potential suicide misclassification), and percentage of Intoxication deaths specifying at least one Drug (indexing fastidiousness of the death investigation process). Results Drug-Intoxication suicide rates ranged from a high of 3.68 deaths per 100,000 persons in New Mexico to 0.65 per 100,000 in North Dakota. The rate ratio of combined accident and undetermined intent to suicide Drug-Intoxication deaths ranged from 16.11 in Louisiana (Drug-Intoxication suicide rate = 0.79 per 100,000) to 2.49 in South Dakota (Drug-Intoxication suicide rate = 1.74 per 100,000). Adjusting for Drug-specification, states with a decentralised coroner system were 46 times more likely to have a high rate ratio (>7.00) of the combined accident plus undetermined intent to suicide Drug-Intoxication deaths as states with a centralised medical examiner system (95% CI, 3.14–1750.22). Conclusions Results suggest that the numerous jurisdictions not meeting rigorous standards for conducting medicolegal death investigations are excessively prone to differentially undercounting Drug-Intoxication suicides. Significance and contributions There is a national urgency to have uniform state and local death investigation and reporting systems that meet high standards in ascertaining manner of death and providing appropriate surveillance data for evidence-based interventions.
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confronting death from Drug self Intoxication ddsi prevention through a better definition
American Journal of Public Health, 2014Co-Authors: Ian R H Rockett, Eric D Caine, Nestor D Kapusta, Kurt B. Nolte, Ted R Miller, Gordon S Smith, Randy Hanzlick, Luke G Larkin, Charles P E Naylor, Sandra L PutnamAbstract:Suicide and other self-directed violence deaths are likely grossly underestimated, reflecting inappropriate classification of many Drug Intoxication deaths as accidents or unintentional and heterogeneous ascertainment and coding practices across states. As the tide of prescription and illicit Drug-poisoning deaths is rising, public health and research needs would be better satisfied by considering most of these deaths a result of self-Intoxication. Epidemiologists and prevention scientists could design better intervention strategies by focusing on premorbid behavior. We propose incorporating deaths from Drug self-Intoxication and investigations of all poisoning deaths into the National Violent Death Reporting System, which contains misclassified homicides and undetermined intent deaths, to facilitate efforts to comprehend and reverse the surging rate of Drug Intoxication fatalities.
