Alcohol estimation at necropsy: Epidemiology, economics, and the elderly

Aims-To gather data on blood alcohol concentrations in a forensic necropsy population and to analyse the information on trends that may predict where alcohol testing is going to prove cost-effective. Methods-Alcohol assays were performed on blood, urine, and vitreous samples in 1620 consecutive medicolegal necropsy examinations. Results-Alcohol was detected in only 7% of natural deaths from all causes and in four of 40 deaths categorised as unknown/obscure. Alcohol concentrations greater than or equal to 350 mg/100 mi were found in nine drug/alcohol abuse deaths (range 363-506 mg/100 mi), five accidental deaths (356-504 mg/100 mi), and one homicide victim (400 mg/100 mi). Those categorised as alcohol abusers were represented in all but one category of death (unknown/obscure deaths in males), showing that many true alcoholics die with their alcoholism rather than of it; 39% of males and 34% of females with histories of alcohol abuse had alcohol present in their blood at necropsy at concentrations greater than or equal to 50 mg/100 mi, u only 9% (male) and 6% (female) without such history. Conclusions-The study highlights the problems of elderly and ''hidden'' alcoholics and illustrates cases where routine assays would provide additional significant information. Routine alcohol testing is useful in all cases of suspected unnatural death but universal testing of forensic necropsies is not cost-effective.