Clinical severity and medico-legal evaluation in non-suicidal poisoning cases: A retrospective analysis of 2017 – 2024

This study aimed to evaluate the demographic, clinical, and medico-legal characteristics of non-suicidal, non-pharmaceutical poisoning cases assessed in a forensic medicine department. This retrospective cross-sectional study included 108 cases evaluated at a tertiary university hospital forensic medicine department between January 1, 2017 and December 31, 2024. Pharmaceutical exposures and cases with documented suicidal intent were excluded. Poisoning agents were classified as food-related, carbon monoxide (CO), alcohol, mushroom, and other agents. Outcomes were hospitalization, intensive care requirement, life-threatening condition, and injury not manageable by simple medical intervention (SMI), the latter two determined by forensic medicine specialists according to the national forensic guideline. Firth penalized logistic regression was used for multivariable analysis. Of the cases, 55.6% were male, and the mean age was 28.57 ± 18.94 years. The most common agents were food-related (33.3%), alcohol and other agents (21.3% each), and CO (13.0%). Hospitalization occurred in 19.4% of cases, intensive care in 4.6%, and a life-threatening condition with non-SMI status, in 17.6% of cases (19/19). No life-threatening outcome was observed in food-related poisonings, whereas CO- and alcohol-related poisonings showed significantly greater severity (p < .001). Respiratory distress was strongly associated with life-threatening condition (OR = 121.00; 95% CI: 13.80 – 1061.12) and hospitalization (OR = 21.00; 95% CI: 4.98 – 88.62). Consistent with the guideline's own carboxyhaemoglobin threshold for carbon monoxide poisoning (above 20%), all CO cases in our series with carboxyhaemoglobin at or above 25% were classified as life-threatening, against 12.5% below this cutoff (p = .005). CO exposure independently predicted life-threatening condition (aOR = 156.40; 95% CI: 1.40 – 17503.77; p = .036), although the interval width permits only a directional reading. Physiological severity indicators rather than exposure category alone should govern the forensic determination of life-threatening condition.