To (I) evaluate the reproducibility of a urinary bladder volume cut off of>330ml as an indicator of lethal intoxication and to (II) investigate the correlation of urinary bladder volume with lethal intoxications for different substance subgroups.

We investigated a postmortem study group of individuals with lethal intoxication (n=180) versus a no intoxication control group (n=102 individuals). Urinary bladder volume was taken from the autopsy report. Based on receiver operating characteristic curve (ROC) analysis, we evaluated both lethal intoxication in general and lethal intoxication in the opioid, cocaine, benzodiazepine, psychotropic drug, amphetamine and z-drug subgroups.

Urinary bladder volume was significantly higher in individuals with lethal intoxication in general (median volume 130ml) than in the control group (median volume 8ml). In ROC analysis, bladder volume exhibited good discriminatory performance (AUC 0.71). Sensitivity and specificity were maximized at a cutoff point of 190ml (45%/88%). For the opioid, cocaine, benzodiazepine and amphetamine subgroups as the leading substances, a distended urinary bladder could be confirmed as a possible sign of lethal intoxication. We found no bladder distention in the cases of lethal intoxication with psychotropic drugs and z-drugs as the leading substances.

Our study proves similar cutoffs in urinary bladder volume as a sign of possible intoxication compared to a previous study. However, this cutoff can only be used for opioids, cocaine, benzodiazepines and amphetamines as the leading substances. It is not valid for psychotropic drugs and z-drugs.