Should coroners be able to recognize unintentional carbon monoxide-related deaths immediately at the death scene?

The aim of this retrospective survey of unintentional carbon monoxide-related deaths in Vienna was to determine whether the cherry-pink coloring of livor mortis is a reliable finding for the coroner to suspect a carbon monoxide-related death immediately at the death scene. In addition, we investigated the recognition pattern of unintentional carbon monoxide-related deaths by Viennese coroners between 1984 and 1993. Therefore, we analyzed autopsy reports of postmortems performed at the Viennese Institute of Forensic Medicine between 1984 and 1993. The study involved 182 unintentional carbon monoxide-related deaths: 92 females and 90 males. We found a strong association between the carboxyhemoglobin level and the cherry-pink coloring of livor mortis. In 98.4% of unintentional carbon monoxide-related deaths livor mortis were clearly cherry-pink. During the 10-year study period Viennese coroners recognized only 61% of unintentional carbon monoxide-related deaths immediately at the death scene. The percentage of unrecognized carbon monoxide fatalities with a clear cherry-pink coloring of livor mortis almost doubled from 1984 to 1993. The older the victim, the worse the coroners recognition. In summary, we have shown that coroners should be able to recognize unintentional carbon monoxide-related deaths immediately at the death-scene, because fresh corpses with carboxyhemoglobin levels greater than 31% show a clear cherry-pink coloring of livor mortis. Therefore, coroners should be encouraged to examine naked corpses thoroughly, especially regarding the color of livor mortis. Thus, a carbon monoxide-related death can be recognized immediately and the source of gas release identified as soon as possible protecting people who otherwise would also be at risk of poisoning.(ABSTRACT TRUNCATED AT 250 WORDS)