A case study for local data surveillance in opioid overdose fatalities in Cuyahoga County, OH 2016-2020.

Introduction: Fentanyl and fentanyl analogs have increased the overdose mortality rates in the United States, significantly impacting states like Ohio. We examined carfentanil overdose deaths, other contributing Cause of Death (COD) drugs, and drug seizure trends from 2016 to 2020 in Northeast Ohio.

Materials And Methods: We studied death investigation data from the Cuyahoga County, Ohio Medical Examiner's Office (CCMEO) of all fatal accidental opioid overdoses as well as drug seizure data from Cuyahoga County Regional Forensic Science Laboratory (CCRFSL).

Morphometric data on severely and morbidly obese deceased, established on forensic and non-forensic autopsies.

With the widespread increase in the incidence of obesity, autopsies on severely and morbidly obese deceased have become common in the USA. Standard reference tables for organ weights provide little or no information on individuals with a body mass index greater than 35 kg/m(2). Although several recent reports have provided organ weights for small numbers of morbidly obese persons who died naturally from a variety of causes, these data may have been affected by comorbidities.

Concordance Rate for the Identification of Distant Entrance Gunshot Wounds of the Back by Experienced Forensic Pathologists Examining Only Images of Autopsies.

The images of 66 gunshot entrance wounds with a defect on the back, a bullet in the body, hemorrhage along the wound track, and logical certainty that it was an entrance wound were collected from the files of a moderately busy medical examiner's office. Participants numbering 22 board-certified forensic pathologists viewed a single digital archival image of each of the 66 entrance wounds randomly mixed with 74 presumptive exit wounds to determine whether they were entrance or exit wounds. The concordance rate for correctly identifying the 66 logically known entrance wounds was 82.

An Unusual Feature of Graze Gunshot Wounds.

All graze wounds that occurred in the jurisdiction of the Fulton County Medical Examiners Center over a ten-year period (2005-2014) were inspected. Of a total of 227 graze wounds, 31 (14%) exhibited a previously not well-described feature. At one end of the graze wound, two small, subtle, parallel abrasions separated by a band of spared skin extended away from the wound.

Diffuse bilateral retinal hemorrhages in an infant with a coagulopathy and prolonged cardiopulmonary resuscitation.

We report a case of diffuse bilateral retinal and optic nerve sheath hemorrhages in an 8-week-old boy who was found unresponsive. The child underwent prolonged cardiopulmonary resuscitation and was noted on admission to have a coagulopathy. An autopsy determined the cause of death to be a myocardial infarct in the distribution of an anomalous coronary artery.

Bilateral first rib anomalous articulations with pseudarthroses mimicking healing fractures in an infant with abusive head injury.

Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X-rays.

Routine HIV screening during intake medical evaluation at a County Jail - Fulton County, Georgia, 2011-2012.

Fulton County Jail (FCJ) in Atlanta, Georgia, is one of the 50 largest jails in the nation, with an average daily census of 2,269 detainees. During January 1, 2011-March 15, 2012, FCJ implemented a demonstration project to integrate routine rapid human immunodeficiency virus (HIV) screening into the medical intake process. This report summarizes the results.

Subdural hematoma occurrence: comparison between ethanol and cocaine use at death.

Objective: The objective of this study was to show that, in a medical examiner population, ethanol intoxication is associated with an increase in the occurrence of subdural hematoma (SDH), whereas the presence of cocaine is not associated with an increase in the occurrence of SDH.

Design: This was a retrospective evaluation of 967 SDH including the investigative information, autopsy, and toxicological findings derived from 18,314 medical examiner cases over 8 years.

Results: Subdural hematoma is found in 7% to 9% of cases with either no ethanol or less than 100 mg/dL of ethanol.

Postmortem vitreous beta-hydroxybutyrate: interpretation in a forensic setting.

Vitreous beta-hydroxybutyrate (BHB) was retrospectively analyzed in 1795 forensic cases using the Pointe Scientific method. Comparison of vitreous BHB with vitreous glucose in 1781 of the cases showed moderately good correlation r = 0.731.

The Fulton County Medical Examiner's experience with the Federal Bureau of Investigation National Missing Person DNA Database Program, 2004-2007.

Background: Medical examiners and coroners occasionally encounter unidentified human bodies, which remain unidentified for extended periods. In such cases, when traditional methods of identification have failed or cannot be used, DNA profiling may be used. The Federal Bureau of Investigation has a National Missing Person DNA database (NMPDD) laboratory to which samples may be submitted on such cases and from possible relatives or environments of unidentified decedents.

A 10-year epidemiologic review of homicide cases in children younger than 5 years in Fulton County, GA: 1996-2005.

The primary purpose of this study was to present the epidemiologic review of homicide deaths certified by the Fulton County Medical Examiner's Office from January 1, 1996 through December 31, 2005 in children younger than 5 years. The secondary purpose of this study was to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County are significantly greater than expected when compared with those in the State of Georgia. For purposes of this study, only homicide deaths of Fulton County residents were included.

Postmortem blood cadmium, lead, and mercury concentrations: comparisons with regard to sampling location and reference ranges for living persons.

This study's goal was to determine cadmium (Cd), lead (Pb), total mercury (THg), and inorganic mercury (IHg) levels in human cadavers to compare measured levels with established reference ranges for living persons and to determine whether blood levels varied with time from death to sample collection or by body collection site. Subjects (n = 66) recruited from the Fulton County Medical Examiner's Office in Atlanta, GA, were 20 years of age or older, had no penetrating trauma, no obvious source of environmental contamination of the vasculature, and had whole blood accessible from the femoral (F) site, the cardiac (C) site, or both. Geometric mean results were as follows: 2.

Nonnatural deaths of adolescents and teenagers: Fulton County, Georgia, 1985-2004.

Context: Childhood deaths are carefully scrutinized by many different government agencies, fatality review panels, researchers, and other groups. Many such deaths, especially those that involve external causes such as injury and poisoning, are amenable to prevention. Characterizing the causes and circumstances of nonnatural childhood deaths may provide information that is useful for development of prevention strategies and programs.

Selecting forensic pathology as a career: a survey of the past with an eye on the future.

Background: Each year there are about 30 to 40 physicians who train and become board-certified in the specialty area of forensic pathology, compared with hundreds or thousands in other disciplines. There are not enough board-certified forensic pathologists to cover national need. The National Association of Medical Examiners' (NAME) Forensic Pathology Training Committee conducted a survey of its members to determine which factors influenced them to select forensic pathology as a career, and to offer suggestions about possible recruitment methods in the future.

Evaluation of certifier practices regarding alcohol-related deaths: Fulton County Medical Examiner's Center, Atlanta, Georgia, 2004.

Context: Alcohol can contribute to various manners of death by acute intoxication that places a person at risk for fatal injury, acute fatal alcohol poisoning, or the various fatal complications of chronic abuse with or without superimposed acute intoxication. The reporting of alcohol use on the death certificate may vary with office policy or procedure, certifier judgment, and the timing of information received during investigation.

Objective: To determine the number of deaths including mention of alcohol use in the investigative case file, the number of death certificates on which alcohol use is reported, the number of discrepancies between the 2, and the possible reasons for observed discrepancies.

Pulmonary hemosiderin in deceased infants: baseline data for further study of infant mortality.

Infant lung samples were obtained prospectively at autopsy by medical examiner pathologists in five areas of the United States. Tissues were submitted regardless of the cause of death. Lung sections were stained with Prussian blue to detect deposits of hemosiderin.

Enumerating deaths among homeless persons: comparison of medical examiner data and shelter-based reports--Fulton County, Georgia, 1991.

Characteristics of causes of death and mortality patterns in homeless populations have been constrained by limitations in both the accuracy of estimates of the size of the homeless population and enumeration of the number of deaths of homeless persons (1,2). For example, studies of mortality among homeless persons in Fulton County (Atlanta), Georgia, based on medical examiner records estimated approximately 40 deaths of homeless persons annually (1,3); in contrast, a media report based on information supplied by shelters for homeless persons reported 191 deaths of homeless persons in Atlanta during 1991 (4,5). As a basis for improving characterization of mortality patterns in the homeless population of Fulton County, Emory University and CDC assessed the differences in the estimates of deaths among homeless persons that were obtained from medical examiner records and those based on death reports from shelters that are in or adjacent to Fulton County (1990 population: 648,951) during 1991.

Characteristics of death certifiers and institutions where death is pronounced--Fulton County, Georgia, 1991.

Information from death certificates (DCs) is used to measure health status and to set public health priorities at all levels in the United States. However, because of limitations in the training of physicians who certify deaths, the completeness and accuracy of cause-of-death information varies (1-3). To develop a basis for targeting education of physicians who certify deaths, CDC, in cooperation with the Fulton County (Georgia) Vital Records Office, reviewed a consecutive series of 500 DCs filed in Fulton County (1990 population: 648,951) from April 10 through May 2, 1991, to characterize the number and proportion of personal physicians (PPs) (defined as physician certifiers not acting in the capacity of medical examiners or coroners [MECs]) and MECs certifying death, as well as other factors.

Misclassification of deaths caused by cocaine. An assessment by survey.

The use of U.S. vital statistics for surveillance of drug-related mortality may be limited by the way in which certifiers complete death certificates and by the constraints of the International classification of diseases, Ninth Revision (ICD-9).