Shortcomings of Urine-Preferred Drug Screening on Post-Mortem Specimens

Abstract

Abstract In counties with limited budgets, in order to save money on toxicology work, the request often comes from local medical examiners that screening for drugs on decedents be performed initially on urine and, if positive, to send blood for confirmation; negative urine results are not further evaluated. A study of known urine and blood drug screens was performed to evaluate the clinical and cost-effectiveness of this practice. Results of 401 autopsies were reviewed. In all, 11 decedents had both urine and blood drug screens performed. There were seven men and four women, mean age for both 39 years. In the urine drug screens, there were nine true positive tests, 17 false positives, 45 true negatives, and five false negatives; sensitivity 64%, specificity 73%. The savings in cost were theoretically 34%, but screening urine for drugs on post-mortem specimens does not appear to be an effective way to determine what drugs were present at the time of death. It is inexpensive, however. Still, in a screening practice for which so many of the results are not reliable, one must decide whether the money saved is worth the misleading results. Considering how many critical decisions about cause and manner of death are based on toxicology, it would seem unreliable to choose a urine-preferred practice.