Petechial hemorrhages, ethanol, and opioids in victims from intoxication. (September 2022)

• Record Type: Journal Article
• Authors: Mæhle, Bjørn Ove; Eide, Geir Egil; Morild, Inge; Lilleng, Peer Kaare
• Is Part Of: Forensic science international. Volume 338(2022)
• Publication Date: 2022-09
• Subjects: Intoxication -- Petechial hemorrhages -- Ethanol -- Opioids -- Autopsy; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2022.111406
• Languages: English
• ISSNs: 0379-0738

Abstract

Abstract: Petechial hemorrhages are of interest to forensic pathologists because of their association with pressure on the neck. This study shows the associations between ethanol, opioids in blood and the risk of petechiae in conjunctivae and eye lids of 865 medico-legally examined victims from intoxication, 112 (12.9 %) with petechiae. Livor mortis on the front, face down body position, higher body weight, and younger age of the victims were independently associated with higher risk of petechiae. These variables were used for adjustment in the logistic regression analyzes. We found associations between ethanol, opioids, and the risk of petechiae when analyzed simultaneously. The association between ethanol and the risk of petechiae differed in opioid negative and positive victims (interaction, p = 0.028). In the opioid negative group, the association was J-formed, victims with low to medium level ethanol having lower risk (OR = 0.77) than those without ethanol or opioids, whereas high ethanol level gave a 4-fold higher risk (OR = 3.97). In the opioid positive group, the J-formed pattern was reversed. Victims with low to medium level ethanol had more than 4 times higher risk (OR = 4.65), whereas high level ethanol gave a slightly elevated risk (OR = 1.34) only compared to no ethanol or opioids. The results suggest that ethanol and opioids have a complex association with the risk of petechiae independent of livor mortis, initial body position, body weight, and age in victims from intoxication. Of practical value for the post-mortem examination is that the pathologist must consider both the ethanol level and the presence of opioids when judging the significance of petechiae in the eye regions. Highlights: The risk of petechiae was dependent on the location of livor mortis, age, body weight, and body position. Considering these four variables, the blood level of ethanol and presence of opioids were associated with petechiae. High ethanol level had high risk of petechiae and medium level had low risk compared with ethanol / opioid negative victims. The association between ethanol and petechiae was reversed in opioid positive victims.