MDI Myth: Rapid Toxicology Screening Tools Can Replace Traditional Toxicology Testing – No Need to Confirm

This session will bust the myth that new toxicology screening tools can fully replace traditional toxicology testing. This session will discuss the appropriate integration of current rapid toxicology screening tools into medical examiner and coroner (MEC) offices as a method of triaging cases, rather than a determination of toxicology related causes of deaths. Topics covered in this webinar will include the rationale for rapid screening at different points in the investigation (e.g., triage of case); differences between toxicology screening and confirmation testing; and exemplar case studies to highlight salient points.   

Postmortem forensic toxicology is a well-established science that combines analytical and interpretive skills based on sound findings and other case-related information. In respect to analyses in postmortem toxicology, there have historically been two means of testing – screens and confirmations. Today, screening testing can be performed using non-specific, e.g., immunoassays, and specific means, e.g., chromatography coupled with mass spectrometry. As any given case has the potential to enter the criminal or civil justice system, there is an inherent expectation that analyses performed must meet regulatory standards, i.e., are analytically defensible. However, there is a growing belief that a minimalistic approach to postmortem toxicological testing is sufficient. Essentially, this translates to some MEC offices only completing rapid screen testing. This approach, while potentially financially beneficial, is fraught with peril and lacks scientific foundation. This presentation will provide a background on how the field has “evolved” to the current state of screen-only in some jurisdictions, demonstrate data that highlights why such an approach is unfounded, and will discuss the perils of a rapid screen-only approach

Detailed Learning Objectives

1. Attendees will understand why the use of screen-only testing in postmortem toxicology is at best incomplete, and at worst, may potentially miss a cause of death.
2. Attendees will understand why screen-only testing in postmortem toxicology abrogates scientific and regulatory requirements.
3. Attendees will understand how rapid toxicology screening has impacted the MEC community.