Toxicology case data reporting system

Forensic Science International, 39 (1933) 143 - 153 Elsevier Scientific Publishers Ireland Ltd.

143

TOXICOLOGY CASE DATA REPORTING SYSTEM*

BRIAN P. JOYNT Tozicology Section, Central Forensic Laboratory, Royal Canadian Mounted Police, P.O. Box 8885, Ottawa KlG JM8 (Can&d (Received January 21st 1988) Revision received March 15th, 1933) (Accepted March 21at, 1933)

Summary A computerized system has been organized to serve the toxicology sections of seven R.C.M.P. laboratories across Canada. Scientists may view and retrieve information concerning drugs and drug combinations, blood and liver drug concentrations, etc. from cases of sudden death or impaired driving which were analyzed in the laboratories. This has proven to be a great help in interpreting toxicology case results for the investigator or the courts and also in choosing methodology to be used in analyzing specimens for unusual drugs or poisons. Key words: Toxicology case data; Electronic data processing; Drug concentrations; Drug effects/ interpretation; Drug interaction; Human body fluids/tissues.

Introduction The R.C.M.P. have eight laboratories in cities across Canada, located in Vancouver, Edmonton, Regina, Winnipeg, Ottawa, Montreal, Sackville and Halifax; of these, all (except Montreal) have toxicology sections. These laboratories each provide forensic services for very large geographical areas. Various methods for the storage and retrieval of case data have been used by these toxicology sections over the years, each of them encompassing extensive paper storage which required cumbersome and time consuming data manipulation. The objectives of the Toxicology Case Data Reporting System detailed here, are as follows: (1) Storage of forensically significant data from actual R.C.M.P. laboratory toxicology cases which can be quickly and easily retrieved by any of the personnel in the laboratories. The system is intended to be a small internal data base. Average growth forecast is approximately 400-500 cases per year. Cases containing only alcohol are not entered on this system. (2) To allow quick and easy data input and retrieval using a *Presented in part at the International Association International Meeting, Banff, Canada, July 27-31,1987. 03794m3/83/$03.50

0 1983 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland

of Forensic Toxicologists

(TIAFT) 24th

144

simple, user-friendly menu-type format. (31 To allow retrieval of data and statistical information in hard copy by the use of predesigned batch reports. (41 To allow retrieval of case data by drug or a combination of drugs, as well as drug concentration ranges in either blood or liver. (5) To provide meaningful detail for each case, including details of analysis, autopsy findings, medical history and circumstances surrounding a death or crime. (61 To provide identification of case reports so that the analyst involved could be contacted should further information or guidance be required in analysis methodology or interpretation of results. (‘71To build a data bank sufficient in size to act as a resource in the interpretation of toxicology results for written reports or before the courts. The system is not designed as a management tool for measuring casework output or individual laboratory performance. Submission

Form

Case details are entered on a submission form by the analyst involved. These forms are then sent to the Central Forensic Laboratory in Ottawa, where the information is entered on the data system. In this way, one may be assured that units of measurement and consistency in format are adhered to. Table 1 outlines the submission form and Table 2 shows the instruction sheet. Note that units may be expressed in either TD (traditional metric units), or SI (international system of units). When quoting units in the Toxicology Case Data Reporting System, TD units are expressed only as mg/lOO ml (gl, where the SI units are expressed as pmolil (kg). It is on this basis that the SI conversion factor for each drug is calculated. When the units concerning drug concentrations in a case are inserted in the system as either TD or SI, all concentrations are automatically expressed in both units. In forensic toxicology, the absence as well as the presence of ethanol in the presence of drugs, may be significant. Therefore, in each case, ethanol is reported as zero, trace, positive, no analysis done, or by concentration. The data system was designed for use on the computer system in place across Canada, which is used by the R.C.M.P. and other police agencies for many aspects of criminal investigation and data retrieval. In this way, the objective of direct access to data by each of the laboratories was met. Computer System Briefly, the computer complex is made up of four main Central Processing Units (CPU) located in central Canada, each having 16 megabytes of main memory. The CPU used for the toxicology program is an ANDAHL computer. Connected to each CPU are many direct access storage devices (DASD), with magnetic tape back-up in case of failure. The software for the system was developed internally on an adaptable database (ADABAS) using Natural language. By using ADABAS, an easy flow, user-oriented language

145 TABLE 1 TOXICOLOGY CASE DATA REPORT - SUBMISSION FORM TOXICULOCY

RCMP CASE

TYPE

FILE

NUMBER:

DATE:

(circle

1

0nc):

uuu

UDI

DUR

F L ----_-_

---SEX :

yrs.

AGE:

:

OTHER FLUIDS/TISSUES

Traditional sheet

WEIGHT:

K?,*

f

-

Indicate instruction

-

m

-

months

LEVELS

CASE UATA REPORT

for

Units (TD) or Metric (SI). standard units which must

(See be used.)

ANALYZED:

URINE: BILE:

-

STOMACH CONTENTS: OTHER:

MEDICAL HISTORY:

1.

Known

2.

Disease:

3.

Known medication:

G.

Psychiatric

5.

Allergy;

COMMENTS:

(suspected)

cause

of

drach:

history: drug

sensitivity:

-

146 TABLE

2

TOXICOLOGY

CASE DATA

REPORT

-

SUBMISSION

FORM INSTRUCTIONS

CASE DATA REPUKT FORM (Instructions) Case

Type:

Based I DDD DDR DDI

File

No.:

Made

on conclusion of analyst, circle one of the Impaired - may include FEIVA, etc. Death due to drug(s) Death, related (no other known cause) drug Death, drug involved (other known cause) up as

follows:

blank

1

-

first i.e.

blank

2&J -

year,

i.e.

blank

4-7

case

number

-

Example:

Date:

Year

Age:

Years

Sex:

Malt?,

Weight:

in

Levels:

Write -

Other

month.

zz

Example:

Months

(use

or

unknown

female

of lab -Ottawa,

location. J!ancouver

0 7 -MUST BE 4 DIGITS

FL II 8 7 0 0 2 5

8704 ----

months -

only

check

for

babies

which

you

and children under 4 years of age.

one

Kilograms in

-TD

or

g

depending

on

arp

using

all (TD) Traditional Units as mg/dL or mg/lODg. all (SI) Metric units as pmol/L or pmol/Kg. Carbon Monoxide: TD unit : % saturation. SI exprrssed RS a brcomrs 0.55 (no units rcq’d.). fraction of 1.0 eg. 55% sat’“. Ethanol and occasionally Carbon Monoxide or a particular drug (which is significant in a case) may require the following: If no analysis, indicate “NOT DONE” I. If a negative result,, indicate “ZERO” 2. If a trace amount, indicate “T” 3. 4. If a positive result, but quantification not done for some reason, indic.lte “I’”

Fluids/Tissues

Isolation:

quant :

and

initial -Ilalifax,

following:

Analyzed:

Carry

through

same

units

as

DSE PROTSE HYDROL DIST cc III-ADSP EMIT OTllER

-

direct solvent extraction protein pr~cipitationlsolvrnt extr;lction chemical or enzyme hydrolysis/extraction distillation C 1 i nr 1IIt R 1 column chrom~rol;r;lphy (~‘g: hr*idsp.lcr tcchn, <,,,c

-

specify

Quantif

ic;ltiotl:

under

under

“Levels”

“Comments”

uv, c;crc, GUFI, f;r:l:C, G(.flr, (;(:ilF. III’I.C. EMIT, VTIII:R (spc*clly undc~r “Commcnts”1. (Indicate if method differs for blood nnd liver.)

Medical HIstory: 1. Known (suspected) cause of dc.lth:’ 2. diabetes. Uisease: alcoholism, eg: 3. Known medication avail.lble 4. Psychiatric history: eg: suicidal, 5. Allerg;, drug (or other) sensitivity.

eg:

FEIVA, gunshot epilepsy, obesity, drpresscd,

wound, etc.

hanging

arc.

Comments: Include dctnils of use, unusual mfdical or phy
147

was possible. The system uses program function (PF) keys as the main driving mechanism, which allows the complete manipulation of data to occur with a single keystroke. Data Input and Retrieval Each member of the toxicology laboratories is provided with a security cleared password and identification number which is used to access the system. After signing on, the user is presented with a menu (Fig. 1). The choice of direction is made by depressing the appropriate PF key. The first seven items are accessible by all members of the R.C.M.P. toxicology sections for data retrieval. The last five items are cleared for use only by personnel in the Central Forensic Laboratory in Ottawa, and are designed for the addition, deletion or modification of data. The functions will be discussed, but not in order of PF number. While a few examples are included in the text, space does not permit complete inclusion of all the many display unit (moniter) screens involved. Suffice to say that one may easily progress from screen to screen by means of userprompted PF keys. Data Input PF keys 08, 09, 10, 11 and 12 are used for data input, deletion and modification. As mentioned previously, only specified personnel are cleared to perform these functions.

148

PFOB case addition Using PF08, five modules are presented in sequence to allow the recording of case data. Abbreviations and other details are used, as can be seen on the submission form (Tables 1 and 21. Certain key areas must be filled in before proceeding to the next module (Fig. 21. Module 2 (Fig. 31 allows the insertion of from 1 to 99 drug names and concentrations along with isolation and quantification methods. Module 3 allows insertion of data for other fluids/tissues, cause of death, medications involved and allergenic and psychiatric history. Module 4 (Comments) allows insertion of any pertinent details of the case or analysis. Module 5 (Case Validation Function) verifies that the particular case number has been added to the data base. PFO9 cake dele taon Using PF09, one inserts the case number for deletion. After the entry executed, the screen indicates that the particular file has been deleted.

is

PFlO drug addition Occasionally, a new drug name is added to the data system drug list. The name is entered along with its SI conversion factor. The subsequent screen indicates storage of the drug and its factor. PFll drug deletion The drug name to be deleted is entered. A second screen the particular drug is no longer included on the drug list. PF12 case modification This function allows

;’ denotes

Fig. 2. Case addition

modification

key

area

- module one.

of case

data

previously

indicates

that

stored.

The

149

T-P-Z

-

One

may

Zero

indicate

(negative

Screen.

entered

When as

Trace,

Positive

result). all

drugs

indicated,

Drugs have then

(not are been

Module

quantified)

entered, entered, 3

is

or

one an

per X

is

presented.

Fig. 3. Case addition - module two.

appropriate case number is inserted, the portion of the stored data is retrieved, then modified. A final screen indicates the storage of the modified data. Data Retrieval PF05 user assistance

This screen is meant for storage of special instructions which may arise from time to time. PFO.4 drug validation Some 250 drug names are listed on the computer, using the most common generic terms. Additions are made to the list as new substances are encountered, including the drug name and SI conversion factor. Selection of PF04 gives the appropriate screen, titled Drug Validation Function. The drug name is typed in. If an incorrect spelling is used, or if the drug is not yet on the system, a notation ‘invalid drug’ appears. If the correct name has been used, the SI conversion factor appears on the screen with the drug name.

150

PF02 multiple drug query The user may input from one to five drug names on this screen. The ‘return’ or ‘enter’ key is depressed. The screen changes to show how many cases on file contain the three drugs specified (Fig. 4). In this case, 209 cases on file contained this drug combination. To view the cases, PF02 is used, for example: hit #l contains the following information (Table 31. One simply continues to use the ‘return’ or ‘enter’ key to view all 209 cases. Should a particular case prove of interest, the user would record the laboratory case number and search that case file for further detail. For example, in case number FLX830662, the user returns to the main menu by depressing PF03 - then PF03 is again depressed to search the particular case file. PFO3 file number query The file number is inserted in the space provided. Depressing the ‘return’ or ‘enter’ key results in the full detailed case file being presented: in this case, in two sequential screens (Tables 4 and 5). PF06 blood level range query and PFOT liver level range query A search may be done for cases which contain up to three specified drugs, which are further qualified by the insertion of limited concentration ranges. For example, depressing PF06 displays a preliminary screen where one chooses a blood range search in either traditional metric units (TD) or SI

151

TABLE DATA

3 OUTPUT

07-04-29 DATE : FILE NUMBER: CASE TYPE: DRUG : TD BLOOD: SI BLOOD: ISOL 1: DRUG : TD BLOOD: SI BLOOD: ISOL 1: DRUG: TD BLOOD: SI BLOOD: ISOL 1:

-

HIT NO. 1 AGE:

FLX830662 DDR ETHANOL 150.0000 32565.0000

65

YRS.

MOS . TD SI

DLAZEPAM 0.0260 0.9130 DSE NORDIAZEPAM 0.0160 0.5910 DSE

TD SI

HIT: SEX: WGT :

1 M KG.

LIVER: LIVER: ISOL 2:

QUANT:

LIVER: LIVER: ISOL 2:

QUANT:

CCEC

QUANT:

CCEC

TD SI

LIVER: LIVER:

units. This choice is made using function keys PF02 or PF03. By depressing PF02, the next screen is presented and the appropriate drug names and concentrations are inserted in TD units. On pressing the return (enter) key, one discovers that three cases have been found which contain the three drugs in the concentration ranges specified (Fig. 5). By depressing PF02, the abbrevi-

TABLE

4

FILE NUMBER QUERY: SCREEN

1

ENTR F I

L

NUMBER

E

QUERY

FLX830662 DDR 8308

FILE NUMBER: CASE TYPE: CASE DATE:

DATE: SEX: WGT: AGE:

87-04-29 M 51 KG. 65 YRS. MOS.

URINE: BILE: STOMACH

:

OTHER : MEDIC:

VALIUM,

DEATH:

SUDDEN

DISEASE: PSYCH:

LITHIUM,

DIABETIC, HISTORY

DIABENESE

UNEXPLAINED HISTORY OF

DEATH OF

ASTHMA

DEPRESSION

ALLERGY: COMMENT:

DECEASED HAD BEEN UNDER STRESS CAUSED WORKLOAD: ALSO MARRIAGE AND FINANCIAL FOUND DEAD IN BED AT HOME.

BY HEAVY DIFFICULTIES.

152 TABLE

5

FILE NUMBER

QUERY: SCREEN

2

MORE DRUG: ETHANOL TO BLOOD: 150.0000 SI BLOOD: 32565.0000 ISOL 1: DRUG: OIAZEPAM TO BLOOD: 0.0260 SI BLOOD: 0.9130 ISOL 1: OSE DRUG: NOROIgEPAM TO BLOOD: 0.0160 SI BLOOD: 0.5910 ISOL 1: OSE

TO LIVER: SI LIVER: ISOL 2:

QUANT: CCFI

TO LIVER: SI LIVER: ISOL 2:

QUANT: CCEC

TO LIVER: SI LIVER: ISOL 2:

QUANT: CCEC

ated format of each case my be viewed, as before. If further detail on a case is needed, one would search that particular case number by selecting PF03 File Number Query. Batch Reports The user may obtain various lots of information in hard copy by ordering batch reports. A few typical examples are shown (Table 6). ============================================================~========= z=== ===I2

TOXICOLOGY

CASE DATA REPORTING

SYSTEti

TO BLOOD LEVEL RANGE SEARCH RESPONSE ===z ;=== ================;=======_==========================~==========~======= :': :i :r"'_.~,.~';~,;~,.~~_~~~~.,,~.,~~~.,,~~~~~~~~~~~~~~~~~~~~~~.,,~~~~,~.,~~.,~~.,~~.,~~,~~,~~,~.,,~~~,~~~~~,~.,, :" :': 3 CASES FOUND :'c :': TO VIEW DEPRESS PF02 OTHERWISE PF03 :'r i i: DRUG: DIAZEPAM ;'c .i RANGE: 0.0150 TO 0.0300 .i :\DRUG: NORDIAZEPAM _,: 2'7 RANGE: 0.0100 TO 0.0500 :L ;i

.: .i ;: 7':

DRUG: ETHANOL RANGE: 80.0000

TO

150.0000 ;i

_li ~~.1;~_~'~~;_;~;~1;~~;.,~~.~~~~~~~~~~~~~~~~~~~.~.~~~.~..~~~..~.~..~~~~~~~~~~~~.~~.~~~~~~~~~.,~.~.~~.~~~..~.~~~ Fig. 5. TD blood level range search response.

153

TABLE

6

BATCH REPORTS TOXREPOl

List

of

al)

case

data

reports

since

TOXREPOZ

List

of

all

case

data

reports

for

TOXREP03

List

of

all

case

data

reports

in

TOXREPO4

List

of

all

valid

TOXREP05

Summary

TOXREPO6

PrIntout

TOXREPO7

List

of

report of all

of

drugs case

a specified cast

data

with

a certain an

date.

lab.

abbreviated

conversion

correlation

input

input

format.

factors.

between

labs.

case. reports

for

an

input

ca.sf

type.

Discussion

The Toxicology Case Data Reporting System has proven itself to be very useful thus far. It is used regularly by toxicologists in the R.C.M.P. laboratories to view cases (or data) similar to those upon which they are working, resulting in easier interpretation of results found for written reports and presentation before the courts. Analysts having problems with methodology in analyzing certain drugs have been able to gain help by contacting analysts in other laboratories who have completed similar cases in the past. Batch reports have been used to gather pertinent case data in order to formulate statistical information for scientific presentation. The system is very easily used. It is meant to be an internal tool for the R.C.M.P. toxicology sections for the storage, manipulation and retrieval of actual case data. It is readily accessible in all R.C.M.P. laboratories from coast to coast and the data is available immediately when data entry is made at the central laboratory. Modifications are planned in the very near future to give the system wider application, e.g., the ‘Case Type’ area will be expanded to include SA (sexual assualtl, FMVA (fatal motor vehicle accident) and OTH (other). The ‘Blood Levels’ area will be expanded to include Blood C (cardiac) and Blood P (peripheral source). This change will allow the recording of two blood concentrations, made pertinent by the phenomenon known as Post Mortem Drug Release. Modifications will be made, of course, with the full participation of the users. Acknowledgements

The author would like to acknowledge the contributions of the following people to the completion of this project. Don MacAulay, computer programmer, Informatics Directorate, R.C.M.P., Ottawa, Canada for the software design. Barbara Bradley, R.C.M.P., Central Forensic Laboratory, Ottawa, Canada for her assistance in the production of this publication.