Lahti R A, Vuori E
Department of Forensic Medicine, University of Helsinki, P.O. Box 40, Helsinki 00014, Finland.
Forensic Sci Int. 2003 Sep 9;136(1-3):35-46. doi: 10.1016/s0379-0738(03)00223-8.
The entire fatal drug poisoning panorama in Finland is considered in terms of three catergories: accidental, self-inflicted and undetermined (whether accidental or with intent to harm) deaths. The study material consisted of all 500 deaths in 1997 that medical examiners, after examination(s) at the Forensic Toxicology Division (FTD) of the Department of Forensic Medicine, University of Helsinki, officially certified as resulting from drug poisoning. These deaths were matched with data on the same deaths registered at Statistics Finland (SF), the national mortality statistics office. The SF register included 72 additional instances of deaths resulting from drug poisoning. In all but two of these cases, the cause-of-death determination was based on a medico-legal inquest with autopsy and forensic toxicological examination(s) and was certified, in most of the cases, as due to the alcohol component in multiple-toxicant combinations. Reclassifying these deaths at SF to the category of drug component is in accordance with current International Classification of Diseases (ICD-10) regulation of coding "to the medicinal agent when combined with alcohol"; the principle and practice, which is recommended to be amended to equalize the status of alcohol and drug when explicitly stated by a forensic examiner as the principal toxicant in combined poisonings. With regard to manner-of-death, the agreement rates between medico-legally proven deaths from drug poisoning and those registered at SF were 79.8% for accidents, 98.5% for suicides and 0% (nil) for undetermined deaths, at the level of three-character external cause codes (E-code). All deaths originally certified as undetermined were re-assigned, most frequently to the category of accidental death. Since within an advanced and sophisticated medico-legal system, a medical examiner's evidence-based statement, even when the conclusion reached is undetermined (as to intent), should be taken as a compelling argument, the practice of reclassification cannot be considered advisable because assembled information is lost. Concerning the assigned drug-specific groups, the agreement according to the manner-of-death between certifications and registrations was fairly good. From among the accidents, however, opioid poisonings were re-assigned in 11 (29.7%) cases, mostly to the drug abuse/dependence categories, i.e. they were considered as natural deaths by the statistics office. The drug-specific observations were possible only by using the codes from the Anatomical Therapeutic Chemical (ATC) classification of drugs. This is why the incorporation of ATC codes into the ICD system, whenever reasonable, is recommended.
意外、自我伤害以及死因不明（无论意外还是蓄意伤害）死亡。研究材料包括1997年经赫尔辛基大学法医学系法医毒理学部门（FTD）检查后，法医正式认证为药物中毒导致的所有500例死亡。这些死亡病例与芬兰统计局（SF）（国家死亡率统计办公室）登记的相同死亡病例数据进行了匹配。SF登记册还包括另外72例药物中毒导致的死亡病例。除两例之外，在所有这些病例中，死因判定基于法医尸检和法医毒理学检查的法医学调查，并且在大多数病例中，认证为多种毒物组合中的酒精成分所致。按照当前国际疾病分类（ICD - 10）“与酒精混合时编码为药物制剂”的规定，将SF登记册中的这些死亡病例重新分类为药物成分类别；当法医明确指出酒精和药物在混合中毒中作为主要毒物时，建议修改这一原则和做法，以平衡酒精和药物的地位。关于死亡方式，在三位数字的外部死因编码（E编码）层面，法医学证明的药物中毒死亡病例与SF登记的病例之间的一致率为：意外死亡79.8%，自杀死亡98.5%，死因不明死亡0%（无）。所有最初认证为死因不明的死亡病例都被重新归类，最常见的是归为意外死亡类别。由于在先进复杂的法医学体系中，即使法医得出的结论是死因不明（关于意图），基于证据的陈述也应被视为有说服力的论据，因此重新分类的做法不可取，因为会丢失汇总信息。关于指定的特定药物组，认证和登记之间根据死亡方式的一致性相当好。然而，在意外死亡病例中，有11例（29.7%）阿片类药物中毒被重新归类，大多归为药物滥用/依赖类别，即统计局将其视为自然死亡。只有使用药物解剖治疗化学（ATC）分类代码才能进行特定药物观察。这就是为什么建议在合理的情况下将ATC代码纳入ICD系统。
