Evaluation of deaths due to carbonmonoxide poisoning which was autopsed in Antalya between 2011-2020

In our study, data on deaths due to CO poisoning autopsied between 2011 and 2020 in Antalya (sociodemographic characteristics of cases, distribution by month and season), origin of death (accident, suicide, murder), autopsy findings, frequency of autopsy, histopathological examination and by evaluating data such as toxicological analysis results; It is aimed to compare with previous studies, to emphasize the points for forensic medicine specialists, to draw attention to the measures that can be taken to reduce deaths caused by CO poisoning and to draw attention to the legal and social arrangements that can be made. 8649 autopsy cases performed in the 10-year period between 01.01.2011 and 31.12.2020 in the Morgue Specialization Department of the Forensic Medicine Institute Antalya Group Presidency were examined and 105 cases who died as a result of CO poisoning were identified. Cases; age, gender, height, weight, occupation, nationality, time of death (year, season, month, day and time), origin of the event, city and place of the event, COHb value, disease history, autopsy findings, toxicological analysis results were examined for the presence of other traumatic findings. According to the data obtained in our study; The male/female ratio was 1.83 (M/F: 68/37) in 105 cases autopsied after death due to CO poisoning in Antalya, the mean age of the cases was 51.8 (min:1, max:95, SD:25.4) ), mean age was 51.6 (min:2, max:91, SD:23.7) in male cases and 52.2 (min:1, max:95, SD:28.6) in female cases. Considering the distribution of the cases according to age ranges; it was observed that the highest number of cases were between 70-79 years of age (n:20, 19%) and 50-59 years of age (n:14, 13.3%). Most of the cases were citizens of the Republic of Turkey (n:98, 93.3%), and 5 cases (4.8%) were found to be Syrians out of 7 cases with foreign nationality. Among the cases autopsied due to CO poisoning, the highest number of cases were observed in January (n:30, 28.6%), December (n:15, 14.3%) and February (n:14, 13.3%) in the winter months. the least was seen in July and September with 0 cases, in June with 2 (1.9%) cases, and in May with 3 (2.9%) cases. In cases who died from CO poisoning, looking at the days of the event, deaths occurred most frequently on Tuesdays (n:18, 17.2%), followed by Thursday (n:16, 15.2%), Monday (n:15, 14.3%) and Wednesday (n:15, 14.3%), respectively, it was determined that the least happened on Saturdays (n:9, 8.6%). In 6 of the cases (5.7%), the date of the event could not be reached. In the distribution according to the days, there was no statistical difference between the days between the days and the weekdays and weekends. When looking at the places where CO poisoning cases occur; it was found that it was most common at home (n:75, 71.4%). When the distribution of the cases according to the origin is examined; It was determined that the origin was accident in 85 (80.9%) cases and suicide in 3 cases (2.9%). In our study, among the cases who died as a result of CO poisoning, no cases of homicide origin were found, and no information could be obtained about the origin in 17 (16.2%) cases. When the cases are evaluated in terms of CO source; it was determined that the most common source was coal stove (n:32, 30.5%). Considering the CO source detected in the cases according to the origin of the event; It was determined that the source of CO in all 3 suicide cases detected was charcoal. The distribution of the CO source according to the origin of the cases was found to be statistically significant (p:0.000) when the cases with no data on the CO source and origin were excluded and the CO sources were grouped as charcoal and others. When the CO source is examined according to the season in which the event occurred; in 23 of the 59 cases that occurred in the winter season, the source of CO was found to be a stove, and a source of CO other than the stove was found in 26 cases, in 10 cases, no information could be obtained about the source of CO. The CO source was the stove in only 9 of the 46 cases that occurred in other seasons other than winter, in 31 cases, a source of CO other than the stove was detected, in 6 cases, no data could be obtained about the CO source. Except for a total of 16 cases of unknown CO source, other cases, CO source; stove and others, season; when grouped as winter and other the difference was found to be statistically significant. When the COHb values detected in the cases were examined; The COHb value of 1 case could not be determined due to the unsuitable sample for the test, and among the other 104 cases, the minimum value was 15.4%, the maximum value was 84.3%, and the average COHb value was 56.5% (SD: 16.07). When the COHb values by gender are examined, it varies between 17.4% and 76.4% in women, and the average COHb value was found to be 52.6% (SD: 15.60), and it was found between 15.4% and 84.3% in men. and the mean COHb value in men was 58.6% (SD:16.04). When the COHb values detected in the cases are divided into certain intervals and grouped; It is noteworthy that the highest number of cases was in the range of 61-70% COHb value with 36 cases, the lowest number of cases was between 10-20% with 4 cases and 81% and above COHb values with 4 cases. When the distribution of the cases according to the place of death was examined in the cases who died as a result of CO poisoning; It was determined that the highest rate of death was the scene of death with 93 (88.6%) cases, 7 (6.7%) cases died in the hospital, and no information could be obtained about the place of death of 5 (4.7%) cases. In our study, when the distribution of the cases according to the postmortem lividity was examined; there were postmortem lividity in 80 (76.2%) cases, postmortem lividity could not be evaluated in a total of 25 (23.8%) cases, including severe body burns in 19 cases and decay in 6 cases. In the distribution of the cases according to the color of the postmortem lividity; dead spots are mostly light red-pink/cherry red (n:68, 64.8%), it was determined that 3 (2.9%) cases in light light red color and 9 (8.5%) cases in other colors were detected. When the cases were examined according to the features detected in the respiratory tract during autopsy; the highest rate (n:28, 26.7%) was detected by smoke soots, and no respiratory tract features were detected in 13 (12.4%) cases. When the cases were examined according to the features detected in the esophagus during autopsy; the highest rate (n:14, 13.3%) was detected by smog, and no features were found in the esophagus in 73 (69.5%) cases. When the cases were evaluated according to their chronic disease status, no data could be obtained regarding the chronic disease status in 51 (48.6%) cases, 23 (21.9%) cases had chronic disease and 31 (29.5%) cases did not have chronic disease. 51 cases for which no data on chronic disease status could be reached will be excluded from the evaluation. The mean COHb value of 31 cases without any chronic disease was 60.1%, and the average COHb value of 23 cases with chronic disease was 50.6%. The difference in mean COHb values according to chronic disease status was found to be statistically significant. When we compare the COHb values of the cases according to age groups; the highest mean COHb value was 68.4% in the 20-29 age group, it was determined that the highest average COHb value was 68.4% in the 20-29 age group, and the lowest average COHb value was 42.4% in the group over 90 years old. A statistically inverse correlation was found between the age of the cases and the COHb value, and it was determined that the COHb value decreased as the age increased, and the COHb value increased as the age decreased. The fact that the COHb value detected in people who died as a result of CO poisoning is low as the age increases, and higher as the age decreases, is attributed to the increased sensitivity to CO with increasing chronic diseases in advanced age. The reason for the multiple death events in CO poisonings; where more than one person can be found in closed environments such as houses and tents used for shelter, given that CO is a colorless, odorless and non-irritating gas and exposure is greater, especially during sleep, this result is considered to be expected. It is understood that cherry red dead spots are seen in some cases, but cases where the dead spots are not cherry red color can also be encountered. Therefore, COHb determination should be made in every case with suspected CO poisoning. In most of the CO poisoning cases, it is seen that the origin is preventable accident, and when we look at the CO sources that cause death, most of them are coal stoves. This health problem can be reduced by regularly checking and maintaining heating and heating appliances that may be a source of CO, ensuring compliance of chimneys, fuels used, ventilation system with standards, and awareness and education of the community about this issue. We are of the opinion that CO sensors can be used to prevent CO exposure in residences and public spaces, and this can be made mandatory by legal regulations to minimize existing accidents.