{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T04:40:07Z","timestamp":1750048807572,"version":"3.41.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001779","name":"Monash University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001779","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Legal Med"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>The post-mortem diagnosis of hyperglycemia and\/or ketoacidosis is challenging and usually requires costly ancillary testing of vitreous humor or serum samples. A screening tool that would help to determine whether ancillary testing is needed is therefore desirable. The aim of this study was to add to the literature testing the validity and diagnostic utility of post-mortem dipstick urinalysis. More specifically, we determined inter-observer agreement of visual dipstick assessment, the correlation between glucose and ketone urine dipstick scores and formal laboratory testing results, and the diagnostic value of specific dipstick scores expressed with likelihood ratios. Results demonstrate almost perfect interobserver agreement for 108 glucose dipstick scores (Fleiss\u2019 kappa 0.914) but only moderate interobserver agreement for 96 ketones dipstick scores (Fleiss\u2019 kappa 0.467). Dipstick glucose scores correlated strongly with vitreous humor glucose levels (Spearman\u2019s rank correlation coefficient of 0.841, <jats:italic>n<\/jats:italic>\u2009=\u2009107). Correlation between ketone dipstick scores and serum levels of beta-hydroxybutyrate (BHB) and blood acetone was also positive but much weaker (0.317, <jats:italic>n<\/jats:italic>\u2009=\u200991; and 0.411, <jats:italic>n<\/jats:italic>\u2009=\u200992, respectively). The diagnostic value of specific dipstick scores was determined by calculating likelihood ratios for substantial hyperglycemia (vitreous humor glucose\u2009&gt;\u200910 mmol\/L), substantial ketoacidosis (serum BHB\u2009&gt;\u20092.50 mmol\/L) and elevated blood acetone (&gt;\u200920\u00a0mg\/L). Our results suggest substantial screening potential of dipstick urinalysis for glucose, especially when scores are at the lower and higher end of the spectrum. Overall, dipstick analysis results for ketones must be interpreted with great caution. A sub analysis of the data showed that a serum BHB above 2.50 mmol\/L was only seen in 1.8% of cases without demonstrable acetone (&gt;\u200920\u00a0mg\/L).<\/jats:p>","DOI":"10.1007\/s00414-025-03477-3","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T16:38:15Z","timestamp":1743784695000},"page":"1893-1902","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-mortem urine dipstick analysis for hyperglycemia and ketoacidosis: observer agreement and diagnostic value"],"prefix":"10.1007","volume":"139","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6132-0479","authenticated-orcid":false,"given":"Joanna M.","family":"Glengarry","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Pricone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8066-0847","authenticated-orcid":false,"given":"Melanie S.","family":"Archer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8590-0945","authenticated-orcid":false,"given":"Hans H.","family":"de Boer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"3477_CR1","doi-asserted-by":"crossref","unstructured":"Madea B, Musshoff F (2007) Postmortem biochemistry. Forensic Science International, 2007. 165(2\u20133): 165\u2013171","DOI":"10.1016\/j.forsciint.2006.05.023"},{"key":"3477_CR2","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s00414-011-0625-y","volume":"126","author":"C Palmiere","year":"2012","unstructured":"Palmiere C, Mangin P (2012) Postmortem chemistry update part I. Int J Legal Med 126:187\u2013198","journal-title":"Int J Legal Med"},{"issue":"6","key":"3477_CR3","first-page":"1153","volume":"71","author":"JA Simerville","year":"2005","unstructured":"Simerville JA, Maxted WC, Pahira JJ (2005) Urinalysis: A comprehensive review. Am Family Phys 71(6):1153\u20131162","journal-title":"Am Family Phys"},{"issue":"6","key":"3477_CR4","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/01.EEM.0000279130.93159.d9","volume":"29","author":"JR Roberts","year":"2007","unstructured":"Roberts JR (2007) Urine dipstick testing: everything you need to know. Emerg Med News 29(6):24\u201327","journal-title":"Emerg Med News"},{"key":"3477_CR5","unstructured":"World Health Organisation (2024) Point-of-care diagnostic tests (POCTS) for sexually transmitted infections (stis). Available from: https:\/\/www.who.int\/teams\/sexual-and-reproductive-health-and-research-(srh)\/areas-of-work\/sexual-health\/sexually-transmitted-infections\/point-of-care-tests. Accessed 25 September 2025"},{"key":"3477_CR6","doi-asserted-by":"publisher","first-page":"p100","DOI":"10.1007\/s12024-007-9018-4","volume":"4","author":"S Felby","year":"2008","unstructured":"Felby S, Nielsen E, Thomsen JL (2008) The postmortem distribution of ketone bodies between blood, vitreous humor, spinal fluid, and urine. Forensic Sci Med Pathol 4:p100\u2013107","journal-title":"Forensic Sci Med Pathol"},{"key":"3477_CR7","doi-asserted-by":"publisher","first-page":"101933","DOI":"10.1016\/j.jflm.2020.101933","volume":"71","author":"C Ginn","year":"2020","unstructured":"Ginn C, Ateh D, Martin J (2020) The use of point-of-care testing to Establish cause of death in the autopsy setting. J Forensic Leg Med 71:101933","journal-title":"J Forensic Leg Med"},{"issue":"4","key":"3477_CR8","first-page":"99","volume":"40","author":"K Lee","year":"2016","unstructured":"Lee K, Koo HN, Kim TG et al (2016) Usefulness of dipstick test for vitreous glucose in autopsy practice. Korean J Lab Med 40(4):99\u2013103","journal-title":"Korean J Lab Med"},{"issue":"6","key":"3477_CR9","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1097\/PAT.0b013e3283650b93","volume":"45","author":"R Mitchell","year":"2013","unstructured":"Mitchell R, Thomas SD, Langlois NE (2013) How sensitive and specific is Urinalysis \u2018dipstick\u2019testing for detection of hyperglycaemia and ketosis? An audit of findings from coronial autopsies. Pathology 45(6):587\u2013590","journal-title":"Pathology"},{"key":"3477_CR10","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.forsciint.2016.06.003","volume":"266","author":"A-M Walta","year":"2016","unstructured":"Walta A-M, Keltanen T, Lindroos K et al (2016) The usefulness of point-of-care (poc) tests in screening elevated glucose and ketone body levels postmortem. Forensic Sci Int 266:299\u2013303","journal-title":"Forensic Sci Int"},{"key":"3477_CR11","unstructured":"Coroners Court of Victoria (2008) Coroners Act 2008. Available from: https:\/\/www.legislation.vic.gov.au\/in-force\/acts\/coroners-act-2008\/042. Accessed on 27 September 2024"},{"key":"3477_CR12","unstructured":"Victorian Institute of Forensic Medicine (2023) Annual report 2022\u20132023. Available from: https:\/\/www.parliament.vic.gov.au\/491b39\/globalassets\/tabled-paper-documents\/tabled-paper-7957\/victorian-institute-of-forensic-medicine-annual-report-2022-23.pdf. Accessed on 27 September 2024"},{"key":"3477_CR13","volume-title":"Statistical methods for rates and proportions","author":"JL Fleiss","year":"2013","unstructured":"Fleiss JL, Levin B, Paik MC (2013) Statistical methods for rates and proportions. John Wiley & Sons Inc., Hoboken, New Jersey"},{"issue":"1","key":"3477_CR14","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159\u2013174","journal-title":"Biometrics"},{"key":"3477_CR15","unstructured":"World Health Organization (2019) Classification of diabetes mellitus. World Health Organization: Geneva. ISBN 978-92-4-151570-2"},{"issue":"2","key":"3477_CR16","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/00000433-199306000-00001","volume":"14","author":"JI Coe","year":"1993","unstructured":"Coe JI (1993) Postmortem chemistry update emphasis on forensic application. Am J Forensic Med Pathol 14(2):91\u2013117","journal-title":"Am J Forensic Med Pathol"},{"key":"3477_CR17","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1016\/j.forsciint.2004.09.006","volume":"146","author":"M Karlovsek","year":"2004","unstructured":"Karlovsek M (2004) Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humour\u2014our experiences. Forensic Sci Int 146:S19\u2013S23","journal-title":"Forensic Sci Int"},{"issue":"1\u20133","key":"3477_CR18","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.forsciint.2008.12.017","volume":"185","author":"B Zilg","year":"2009","unstructured":"Zilg B, Alkass K, Berg S et al (2009) Postmortem identification of hyperglycemia. Forensic Sci Int 185(1\u20133):89\u201395","journal-title":"Forensic Sci Int"},{"key":"3477_CR19","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s00414-011-0614-1","volume":"126","author":"C Palmiere","year":"2012","unstructured":"Palmiere C, Mangin P (2012) Postmortem chemistry update part II. Int J Legal Med 126:199\u2013215","journal-title":"Int J Legal Med"},{"key":"3477_CR20","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s004140050130","volume":"111","author":"B Brinkmann","year":"1998","unstructured":"Brinkmann B, Fechner G, Karger B (1998) Ketoacidosis and lactic acidosis\u2013frequent causes of death in chronic alcoholics? Int J Legal Med 111:115\u2013119","journal-title":"Int J Legal Med"},{"key":"3477_CR21","doi-asserted-by":"publisher","first-page":"110418","DOI":"10.1016\/j.forsciint.2020.110418","volume":"314","author":"YE Hydara","year":"2020","unstructured":"Hydara YE, Zilg B (2020) Postmortem diagnosis of ketoacidosis: levels of beta-hydroxybutyrate, acetone and isopropanol in different causes of death. Forensic Sci Int 314:110418","journal-title":"Forensic Sci Int"},{"key":"3477_CR22","doi-asserted-by":"publisher","first-page":"110726","DOI":"10.1016\/j.forsciint.2021.110726","volume":"321","author":"L Midtlyng","year":"2021","unstructured":"Midtlyng L, H\u00f8iseth G, Luytkis H et al (2021) Relationship between betahydroxybutyrate (BHB) and acetone concentrations in postmortem blood and cause of death. Forensic Sci Int 321:110726","journal-title":"Forensic Sci Int"},{"issue":"4","key":"3477_CR23","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1093\/lpr\/mgs019","volume":"11","author":"A Nordgaard","year":"2012","unstructured":"Nordgaard A, Rasmusson B (2012) The likelihood ratio as value of evidence\u2014more than a question of numbers. Law Probab Risk 11(4):303\u2013315","journal-title":"Law Probab Risk"},{"issue":"4","key":"3477_CR24","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1007\/s00414-021-02754-1","volume":"136","author":"HH De Boer","year":"2022","unstructured":"De Boer HH, Fronczek J, Berger CE et al (2022) The logic of forensic pathology opinion. Int J Legal Med 136(4):1027\u20131036","journal-title":"Int J Legal Med"},{"issue":"3","key":"3477_CR25","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1111\/jdi.13191","volume":"11","author":"K Hieshima","year":"2020","unstructured":"Hieshima K, Sugiyama S, Yoshida A et al (2020) Elevation of the renal threshold for glucose is associated with insulin resistance and higher glycated hemoglobin levels. J Diabetes Invest 11(3):617\u2013625","journal-title":"J Diabetes Invest"},{"issue":"6","key":"3477_CR26","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1056\/NEJMc2313463","volume":"390","author":"AL Schwartz","year":"2024","unstructured":"Schwartz AL (2024) SGLT2 inhibitors and false positive toxicology tests. N Engl J Med 390(6):573\u2013574","journal-title":"N Engl J Med"},{"issue":"6","key":"3477_CR27","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1002\/(SICI)1520-7560(199911\/12)15:6<412::AID-DMRR72>3.0.CO;2-8","volume":"15","author":"L Laffel","year":"1999","unstructured":"Laffel L (1999) Ketone bodies: A review of physiology, pathophysiology and application of monitoring to diabetes. Diab\/Metab Res Rev 15(6):412\u2013426","journal-title":"Diab\/Metab Res Rev"},{"issue":"5","key":"3477_CR28","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1002\/osp4.432","volume":"6","author":"AA Gibson","year":"2020","unstructured":"Gibson AA, Eroglu EI, Rooney K et al (2020) Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet. Obes Sci Pract 6(5):544\u2013551","journal-title":"Obes Sci Pract"},{"issue":"3","key":"3477_CR29","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/0379-0738(93)90211-R","volume":"62","author":"LN Denmark","year":"1993","unstructured":"Denmark LN (1993) The investigation of beta-hydroxybutyrate as a marker for sudden death due to hypoglycemia in alcoholics. Forensic Sci Int 62(3):225\u2013232","journal-title":"Forensic Sci Int"},{"issue":"1\u20133","key":"3477_CR30","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.forsciint.2009.10.019","volume":"198","author":"S Elliott","year":"2010","unstructured":"Elliott S, Smith C, Cassidy D (2010) The post-mortem relationship between beta-hydroxybutyrate (BHB), acetone and ethanol in ketoacidosis. Forensic Sci Int 198(1\u20133):53\u201357","journal-title":"Forensic Sci Int"},{"key":"3477_CR31","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.forsciint.2017.01.002","volume":"274","author":"N Sadones","year":"2017","unstructured":"Sadones N, Lambert WE, Stove CP (2017) The (non) sense of routinely analysing beta-hydroxybutyric acid in forensic toxicology casework. Forensic Sci Int 274:38\u201343","journal-title":"Forensic Sci Int"},{"key":"3477_CR32","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1016\/j.forsciint.2017.02.021","volume":"279","author":"C Palmiere","year":"2017","unstructured":"Palmiere C (2017) The (non) sense of routinely analyzing beta-hydroxybutyrate in forensic toxicology casework. Forensic Sci Int 279:e18\u2013e19","journal-title":"Forensic Sci Int"}],"container-title":["International Journal of Legal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00414-025-03477-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00414-025-03477-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00414-025-03477-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T04:04:24Z","timestamp":1750046664000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00414-025-03477-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["3477"],"URL":"https:\/\/doi.org\/10.1007\/s00414-025-03477-3","relation":{},"ISSN":["0937-9827","1437-1596"],"issn-type":[{"type":"print","value":"0937-9827"},{"type":"electronic","value":"1437-1596"}],"subject":[],"published":{"date-parts":[[2025,4,3]]},"assertion":[{"value":"6 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Institutional Ethics Committee Approval was sought and granted for the performance of this project and publication of the results (VIFM Research Advisory Committee application number 1264).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}