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Journal of Health, Population, and... Dec 2014Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where... (Review)
Review
Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning-global funding, political will, scale, sustainability, and capacity building; (ii) engaging-coordination, involvement of appropriate individuals; (iii) executing-focused action, multisectoral actions, quality of execution; and (iv) evaluating-rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings.
Topics: Adolescent; Bangladesh; Child; Child, Preschool; Developing Countries; Drowning; Health Plan Implementation; Humans; Infant; Poverty; Risk Factors
PubMed: 25895188
DOI: No ID Found -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Aug 2022Traffic accidents are among the most common causes of death. A small proportion of drownings are associated with traffic accidents. The roads in the Eastern Black Sea...
BACKGROUND
Traffic accidents are among the most common causes of death. A small proportion of drownings are associated with traffic accidents. The roads in the Eastern Black Sea Region, where the study was conducted are fairly close to the seas, rivers, and ponds. This study aims to evaluate the cases who underwent autopsies after the traffic accident between 2009 and 2016 and who were found to have died as a result of drowning.
METHODS
A retrospective examination was made of the autopsy reports in the period 2009-2016.
RESULTS
As a result of the examination of forensic reports, from a total of 7124 autopsies performed in our center between 2009 and 2016, 41 (0.57%) were seen to be due to death in a traffic accident that resulted in drowning. Of the vehicles involved in the ac-cidents, 30 (73.2%) were retrieved from a river/stream, 7 (17.1%) from a lake, and 4 (9.7%) from the sea. In all 39 cases, the primary cause of death was determined as asphyxia related to drowning. Other reasons affecting death were traumatic intracranial bleeding in 7 (17.1%) cases, medulla spinalis injury in 4 (9.7%), and pulmonary injury in 2 (4.9%).
CONCLUSION
It was determined in the study that the typical autopsy results of trauma and drowning after a traffic accident could coexist. Drowning alone could be the cause of death, even though there was a traumatic origin such as a traffic accident in such cases. It was revealed that chemical and microscopic examinations should be handled together with crime scene results and eyewitness statements in addition to traumatic results during the examination phase.
Topics: Accidents; Accidents, Traffic; Automobiles; Cause of Death; Drowning; Humans; Retrospective Studies
PubMed: 35920420
DOI: 10.14744/tjtes.2021.35915 -
Journal of Forensic and Legal Medicine Oct 2023Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature... (Meta-Analysis)
Meta-Analysis Review
Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature of post-mortem findings obtained through classical autopsy methods. Our manuscript addresses this issue by focusing on the emerging use of paranasal sinus fluid as a valuable tool in determining the cause of death, specifically in distinguishing drowning from non-drowning cases. The study provided a comprehensive summary of available evidence from observational studies that compared findings in the paranasal sinuses between drowning and non-drowning victims, analyzing parameters such as the presence of fluid, fluid volume, and density. The study encompassed a total of 14 selected studies involving 1044 subjects and utilized rigorous risk of bias assessment and data synthesis techniques. The meta-analysis demonstrated a strong association between the presence of fluid in the paranasal sinuses and drowning (OR = 17.1; 95% CI 7.2 to 40.5; p < 0.001). In addition, drowning victims had a significantly greater volume of fluid (SMD = 0.8; 95% CI 0.5 to 1.2; p < 0.001) and lower fluid density (SMD = -1.4; 95% -2.5 to -0.4; p = 0.008) compared to non-drowning cases. The results support the utility of paranasal sinus fluid analysis as a valuable diagnostic method in cases where drowning is suspected but cannot be definitively confirmed through traditional approaches.
Topics: Humans; Drowning; Cause of Death; Tomography, X-Ray Computed; Paranasal Sinuses; Autopsy
PubMed: 37717366
DOI: 10.1016/j.jflm.2023.102591 -
Journal of Forensic and Legal Medicine Aug 2019Although the diagnosis of drowning may appear straightforward the reality is that it is sometimes one of the most difficult in forensic pathology. To begin with, there... (Review)
Review
Although the diagnosis of drowning may appear straightforward the reality is that it is sometimes one of the most difficult in forensic pathology. To begin with, there is no universal agreement on what constitutes drowning with some definitions using the term in the absence of a lethal outcome. Next are the significant problems that arise in finding immersed bodies and in assessing the death scene. Prolonged post mortem intervals are associated with artefactual modifications of the body from putrefaction and post mortem animal predation. Both of these may create and disguise injuries. The absence of pathognomonic pathological features at autopsy and the presence of potentially life threatening underlying organic illnesses complicate determination of both the cause and manner of death. There may even be no autopsy findings to indicate that immersion had occurred. Finally, the unreliability of laboratory tests with significant overlap with control cases where death had no association with immersion presents further problems. Thus lethal drowning remains a complex event that requires the use of a wide variety of information sources, not just data gleaned from the dissection table.
Topics: Animals; Aorta; Comorbidity; Consensus; Diatoms; Drowning; Electrolytes; Forensic Pathology; Hemorrhage; Humans; Lung; Organ Size; Paranasal Sinuses; Postmortem Changes; Respiratory System; Skin; Spleen; Terminology as Topic; Tomography, X-Ray Computed; Tunica Intima
PubMed: 31229802
DOI: 10.1016/j.jflm.2019.06.003 -
International Journal of Legal Medicine May 2023If a dead body is discovered in water, it nearly always raises the question about the cause of death, often associated with the persistent problem to differentiate...
If a dead body is discovered in water, it nearly always raises the question about the cause of death, often associated with the persistent problem to differentiate between a drowning incident and post-mortem immersion. In numerous cases, a reliable confirmation of death by drowning is often only possible by a combination of diagnoses obtained from autopsy and additional investigations. As to the latter, the use of diatoms has been suggested (and debated) since decades. Based on the consideration that diatoms are present in almost every natural waterbody and are unavoidably incorporated when water is inhaled, their presence in the lung and other tissues can provide evidence of drowning. However, the traditional diatom test methods are still subject of controversial discussion and suspected of erroneous outcome, predominantly through contamination. A promising alternative to minimize the risk of erroneous outcome seems to be disclosed by the recently suggested MD-VF-Auto SEM technique. Especially the establishment of a new diagnostic marker (L/D ratio), which represents the factorial proportion between the diatom concentration in lung tissue and the drowning medium, allows for clearer distinction of drowning and post-mortal immersion and is largely robust to contamination. However, this highly elaborated technique requires specific devices which are frequently unavailable. We therefore developed a modified method of SEM-based diatom testing to enable the use on more routinely available equipment. Process steps such as digestion, filtration, and image acquisition were thoroughly broken down, optimized, and ultimately validated in five confirmed drowning cases. Taking certain limitations into consideration, L/D ratio analysis provided promising results, even in cases of advanced decomposition. We conclude that our modified protocol indeed opens a way for a broader use of the method in forensic drowning investigation.
Topics: Humans; Diatoms; Drowning; Forensic Pathology; Lung; Water
PubMed: 36869250
DOI: 10.1007/s00414-023-02970-x -
Injury Prevention : Journal of the... Oct 2019Globally, rivers are a common drowning location. In Australia, rivers are the leading location for fatal drowning. Limited information exists on exposure and impact on...
INTRODUCTION
Globally, rivers are a common drowning location. In Australia, rivers are the leading location for fatal drowning. Limited information exists on exposure and impact on river drowning risk.
METHODS
Australian unintentional fatal river drowning data (sourced from coronial records) and nationally representative survey data on river visitation were used to estimate river drowning risk based on exposure for adults (18 years and older). Differences in river drowning rates per 100 000 (population and exposed population) were examined by sex, age group, activity prior to drowning, alcohol presence and watercraft usage.
RESULTS
Between 1 January 2014 and 31 December 2016, 151 people drowned in Australian rivers; 86% male and 40% aged 18-34 years. Of survey respondents, 73% had visited a river within the last 12 months. After adjusting for exposure: males were 7.6 times more likely to drown at rivers; female drowning rate increased by 50% (0.06-0.09 per 100 000); males aged 75+ years and females aged 55-74 years were at highest risk of river drowning; and swimming and recreating pose a high risk to both males and females. After adjusting for exposure, males were more likely to drown with alcohol present (RR=8.5; 95% CI 2.6 to 27.4) and in a watercraft-related incident (RR=25.5; 95% CI 3.5 to 186.9).
CONCLUSIONS
Calculating exposure for river drowning is challenging due to diverse usage, time spent and number of visits. While males were more likely to drown, the differences between males and females narrow after adjusting for exposure. This is an important factor to consider when designing and implementing drowning prevention strategies to effectively target those at risk.
Topics: Adult; Age Distribution; Aged; Australia; Drowning; Female; Humans; Male; Middle Aged; Recreation; Risk Factors; Rivers; Sex Distribution; Swimming; Young Adult
PubMed: 29875291
DOI: 10.1136/injuryprev-2018-042819 -
Chest Aug 2020Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable...
BACKGROUND
Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles.
METHODS
This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in ICUs located in France, French Polynesia, and the French Antilles. Patients were classified according to the drowning classification system proposed by Szpilman.
RESULTS
During the study period, 312 drowning patients were admitted with severe clinical presentation (grades 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (emergency medical services), starting from the prehospital period. Although the global hospital mortality was similar to that previously reported (18.5%), great differences existed among the severity grades. Respective grade mortalities were low for grades 2 through 5 (grade 2, 0%; grade 3, 3%; grade 4, 0%; grade 5, 2%), and the mortality for grade 6 remained similar to that previously reported (54%). These results confirmed that the occurrence of cardiac arrest after drowning is still bad prognosis. Conversely, for other grades, this study strengthens the importance of specialized intervention to interrupt the drowning process.
CONCLUSIONS
On the basis of these results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, the prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.
Topics: Adult; Aged; Drowning; Emergency Medical Services; Female; France; Heart Arrest; Hospital Mortality; Humans; Male; Middle Aged; Near Drowning; Polynesia; Prognosis; Resuscitation; Retrospective Studies; West Indies
PubMed: 32067943
DOI: 10.1016/j.chest.2020.01.035 -
Fa Yi Xue Za Zhi Feb 2022To explore the application values of diatom artificial intelligence (AI) search system in the diagnosis of drowning.
OBJECTIVES
To explore the application values of diatom artificial intelligence (AI) search system in the diagnosis of drowning.
METHODS
The liver and kidney tissues of 12 drowned corpses were taken and were performed with the diatom test, the view images were obtained by scanning electron microscopy (SEM). Diatom detection and forensic expert manual identification were carried out under the thresholds of 0.5, 0.7 and 0.9 of the diatom AI search system, respectively. Diatom recall rate, precision rate and image exclusion rate were used to detect and compare the efficiency of diatom AI search system.
RESULTS
There was no statistical difference between the number of diatoms detected in the target marked by the diatom AI search system and the number of diatoms identified manually (>0.05); the recall rates of the diatom AI search system were statistically different under different thresholds (<0.05); the precision rates of the diatom AI system were statistically different under different thresholds(<0.05), and the highest precision rate was 53.15%; the image exclusion rates of the diatom AI search system were statistically different under different thresholds (<0.05), and the highest image exclusion rate was 99.72%. For the same sample, the time taken by the diatom AI search system to identify diatoms was only 1/7 of that of manual identification.
CONCLUSIONS
Diatom AI search system has a good application prospect in drowning cases. Its automatic diatom search ability is equal to that of experienced forensic experts, and it can greatly reduce the workload of manual observation of images.
Topics: Artificial Intelligence; Diatoms; Drowning; Humans; Liver; Lung; Microscopy, Electron, Scanning
PubMed: 35725702
DOI: 10.12116/j.issn.1004-5619.2021.410719 -
Fa Yi Xue Za Zhi Feb 2022To study the phenomenon of pulmonary hypostasis in corpses of various causes of death, and to explore the potential value of this phenomenon in assisting forensic...
OBJECTIVES
To study the phenomenon of pulmonary hypostasis in corpses of various causes of death, and to explore the potential value of this phenomenon in assisting forensic pathological diagnosis of drowning.
METHODS
A total of 235 cases with clear cause of death through systematic autopsy were collected from January 2011 to June 2021 in Guangzhou. According to the location of body discovery, the cases were divided into the water body group (97 cases) and the nonwater body group (138 cases), and the water body group was further divided into the water drowning group (90 cases) and the water nondrowning group (7 cases). Non-water body group was further divided into the nonwater drowning group (1 case) and the nonwater nondrowning group (137 cases). Three senior forensic pathologists independently reviewed autopsy photos to determine whether there was hypostasis in the lungs. The detection rate of pulmonary hypostasis was calculated.
RESULTS
The detection rate of pulmonary hypostasis in the water drowning group (90 cases) was 0, and the negative rate was 100%. The detection rate of pulmonary hypostasis in the water nondrowning group (7 cases) was 100% and the negative rate was 0. The detection rate of pulmonary hypostasis in the water body group and in the nonwater body group (after excluding 2 cases, 136 cases were calculated) was 7.22% and 87.50%, respectively. There were statistically significant differences in the detection rate of pulmonary hypostasis between water body group and nonwater body group, and between water drowning group and water nondrowning group (<0.05).
CONCLUSIONS
The disappearance of pulmonary hypostasis can be used as a specific cadaveric sign to assist in the forensic pathological diagnosis of drowning.
Topics: Autopsy; Drowning; Forensic Pathology; Humans; Lung; Water
PubMed: 35725707
DOI: 10.12116/j.issn.1004-5619.2021.410920 -
Annals of the New York Academy of... Nov 2014For millennia, human beings have wondered what happens after death. What is the first-person experience of dying and being brought back to life? Technological advances...
For millennia, human beings have wondered what happens after death. What is the first-person experience of dying and being brought back to life? Technological advances in resuscitation science have now added an intriguing new chapter to the literature of out-of-body or near-death experiences by eliciting detailed and vivid accounts of those who have approached the threshold of death. Steve Paulson, executive producer and host of To the Best of Our Knowledge, moderated a discussion that included neurologist Kevin Nelson, neuropsychiatrist Peter Fenwick, emergency medicine expert Sam Parnia, and orthopedic surgeon and drowning survivor Mary Neal; they share some remarkable stories and discuss how they analyze such experiences in light of their own backgrounds and training. The following is an edited transcript of the discussion from December 11, 2013, 7:00-8:30 PM, at the New York Academy of Sciences in New York City.
Topics: Attitude to Death; Death; Humans; Near Drowning; Resuscitation
PubMed: 25059901
DOI: 10.1111/nyas.12473