Postmortem ethanol in the setting of ethanol-containing automotive fuel.

The pilot of a light aircraft that crashed after a loss of power was found to have ethanol in the vitreous and the blood, but almost none in the urine. The globes of the eyes were intact, and the body was refrigerated after recovery until the autopsy was performed the following morning. The pilot was described as a "nondrinker," and additional specialized toxicology testing results were inconsistent with ethanol ingestion. The pilot's body was extensively exposed to fuel during the prolonged extraction. Investigation determined that the aircraft had been fueled with gasoline that contained 10% ethanol. Although exposure to automotive fuel has not been previously described as a source of ethanol in postmortem specimens, it may represent a source for the ethanol detected during postmortem toxicology testing in this case, and this finding may be relevant to other cases with similar exposure.

Using death certificates and medical examiner records for adolescent occupational fatality surveillance and research: a case study.

Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that occupation and employer are properly coded when dealing with adolescent worker deaths.

Work-related fatalities among youth ages 11-17 in North Carolina, 1990-2008.

BACKGROUND: Local and national surveillance systems are in place that identify occupational deaths. However, due to certain restrictions, they are limited in their ability to accurately count these deaths among adolescent workers. METHODS: In this population-based study, we relied on primary data from the North Carolina medical examiner system to identify and describe all work-related fatalities among North Carolina youth under age 18 between 1990 and 2008. RESULTS: We identified 31 work-related deaths among youth ages 11-17. The majority occurred between 1990 and 1999. Most occurred in construction and agriculture. Vehicles and guns were responsible for the majority of deaths. CONCLUSIONS: Although the prevalence of adolescent work-related fatalities has seen a decline in North Carolina, the 31 deaths we detected signal a failure of the systems in place to prevent young worker fatalities. More remains to be done to protect the lives of adolescent workers.

Pattern of injury in child fatalities resulting from child abuse.

According to the US Department of Health and Human Services, in 2005, an estimated 1460 children died of maltreatment. The purpose of this study is to further examine the pattern of bony injuries in child maltreatment fatalities, with an emphasis on the prevalence of antemortem fractures and the presence of associated perimortem fractures. The sample was 162 male and female children. The majority of the data were collected from the case files of the NC Child Fatality Prevention Team at the Office of the Chief Medical Examiner in Chapel Hill, North Carolina (n=152) spanning from 2000 to 2005. An additional 10 cases from 2001 to 2006 were included from the Charleston County Coroner's Office, Charleston, SC. Six age categories were used in this study: 0-3 months, 4-6 months, 7-9 months, 10-16 months, 17 months to 2 years, and 2-6 years. Lesions were documented and categorized into four general body loci: craniofacial, thoraco/abdominal, appendicular, and multiple. The peak age categories of death were 0-3 months (25%) and 2-6 years (19%), with 50% of deaths occurring in infants 9 months old or younger. The body locus most frequently affected was craniofacial.

Sudden infant death syndrome risk factors with regards to sleep position, sleep surface, and co-sleeping.

We present a study of 102 Sudden Infant Death Syndrome (SIDS) deaths using a retrospective review of medical examiner autopsy reports. The prevalence of sleep related risk factors with regards to sleep surface, sleep position, and co-sleeping were determined in a population of infants less than 1-year-old. Of the 102 SIDS deaths, 67 (65.7%) were not in a crib, 63 (61.8%) were prone, and 48 (47.1%) were co-sleeping. However, 94 (92.2%) of these deaths had at least one risk factor present. Only 8 (7.8%) infants had slept alone, in a crib or bassinet, and on their back or side. Infants less than 4-months-old had a higher rate of co-sleeping (54.7%) than the older infants (25.9%), and a higher frequency of heart malformations at post-mortem examination. The older infants were more likely to exhibit pulmonary and tracheal inflammation, and neuropathology.

From gunstore to smoking gun: tracking guns that kill children in North Carolina.

PURPOSE: This study reviews the epidemiology of pediatric firearm deaths in North Carolina and estimates the time from the retail sale of guns to their involvement in pediatric firearm deaths. METHODS: The authors reviewed autopsy reports for all children 0 to 14 years of age that died of firearm-related injuries in North Carolina from January 1999 through December 2002. Data obtained included demographic information, firearm type, and manner of death. Data from the Bureau of Alcohol, Tobacco and Firearms, which traced guns involved in crimes and determined the time elapsed from purchase to their involvement in a crime (ie, time-to-crime were also reviewed). RESULTS: During the study period, 40 children died of firearm injuries. Mean age was 7.6 years. Handguns were responsible for the majority of deaths (59%) followed by shotguns (27%), rifles (10%), and undetermined cause (10%). Most deaths were homicides (67%) followed by unintentional death (18%), suicide (13%), and undetermined cause (2%). Most crime guns (76%) were purchased legally, and many (40%) had a time-to-crime of less than 3 years. CONCLUSIONS: Legally purchased firearms pose a significant threat to children in North Carolina. A more restrictive approach to the sale of handguns is a logical approach to reducing pediatric firearm-related deaths in the United States.