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Forensic Science International Jan 2022Drowning is a significant public health problem worldwide and the WHO reported that drowning is the world's third leading unintentional injury death. Nevertheless, there...
INTRODUCTION
Drowning is a significant public health problem worldwide and the WHO reported that drowning is the world's third leading unintentional injury death. Nevertheless, there is still uncertainty regarding the estimate of local and global drowning deaths. In addition, the postmortem diagnosis of drowning is challenging and the physiological mechanisms of death by drowning are complex and not very well understood.
PURPOSE
To analyze a large series of bodies retrieved from the water in Connecticut (U.S.) in order to compare epidemiologic and toxicological data with those of the literature, as well as to examine the weights of the lungs and brains in drowning deaths.
MATERIAL AND METHOD
We conducted a descriptive, retrospective, population-based analysis of all bodies retrieved from the water and subjected to a forensic autopsy at the Office of the Chief Medical Examiner in Connecticut (2008-2020, n = 500). Variables collected were sex, age, date of death, location of drowning, season, type of water, cause of death, manner of death, circumstances of death, signs of decomposition, BMI, brain weight, lung weight, presence of pulmonary edema, stomach contents, and toxicological analysis.
RESULTS
The death rates of drownings in Connecticut ranges from 0.75 to 1.28/100,000/year. They occurred predominantly in males (73.4%) and most were accidents (75.6%), though this gender difference diminishes in suicides (55.4% of males). Sex distribution is also different in bathtub drownings, where women drown more frequently (67.3%). Weights of the brains (p = 0.013) and lungs (p < 0.001) were higher in saltwater drownings.
CONCLUSIONS
Drowning is more frequently an accident involving men, except for suicides where there is only a slight difference among sex. Heavy lungs and cerebral edema continue to be identified in numerous drowning deaths. These anatomic findings, however, must still be interpreted in the context of the entire case investigation. Weights of the brains and lungs are higher in salt water, although these organs' weights are mostly dependent on other variables such as BMI and decomposition.
Topics: Autopsy; Drowning; Female; Humans; Male; Retrospective Studies; Suicide; Water
PubMed: 34894613
DOI: 10.1016/j.forsciint.2021.111137 -
Anesthesiology Jun 2009Over the past four decades, we have learned considerably more about the pathophysiology and treatment of drowning. This, coupled with increased emphasis in improvement... (Review)
Review
Over the past four decades, we have learned considerably more about the pathophysiology and treatment of drowning. This, coupled with increased emphasis in improvement in water safety and resuscitation, has produced a threefold decrease in the number of deaths, indexed to population, from drowning in the United States yearly. This review presents the current status of our knowledge of the epidemiology, the pathophysiology of drowning and its treatment, updates the definitions of drowning and the drowning process, and makes suggestions for further improvement in water safety.
Topics: Acid-Base Equilibrium; Animals; Drowning; Emergency Medical Services; Humans; Lung; Near Drowning; Pulmonary Gas Exchange; Respiratory Mechanics; Terminology as Topic
PubMed: 19417599
DOI: 10.1097/ALN.0b013e3181a4c3b8 -
Italian Journal of Pediatrics Jun 2023Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The... (Review)
Review
Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.
Topics: Adolescent; Humans; Child; Drowning; Resuscitation; Oxygen
PubMed: 37316902
DOI: 10.1186/s13052-023-01464-1 -
Journal of Injury & Violence Research May 2023Past studies have shown a lack of consensus on the definition and terminology of drowning among experts in the field and relevant organizations. There is a need for a... (Review)
Review
BACKGROUND
Past studies have shown a lack of consensus on the definition and terminology of drowning among experts in the field and relevant organizations. There is a need for a new look at the definition of drowning to improve the understanding of drowning events.
METHODS
A literature search of seven electronic databases, including PubMed, EMBASE, CINHAL, MEDLINE, Sport Discus, and Social Sciences from 1960 to 2020 was conducted using the MESH search terms "drowning", "near-drowning", "submersion", and "immersion". Cochrane databases were also searched for systematic reviews The items were searched in all fields of publication, including title, abstract, and keyword.
RESULTS
The search identified approximately 2500 articles, 230 of which were reviewed. The inclusion criteria were applied to the full text of 230 articles, and 25 articles addressing the different definitions of drowning were assessed. They were reviewed critically by authors using a standard review form. The search identified that there were at least 20 different outcome measures for drowning incidents reported. Definitions of drowning in the literature were found for the following terms: dry versus wet drowning, secondary drowning, drowned and near-drowned, drowning without aspiration and drowning with aspiration, near drowning without aspiration or with aspiration, active drowning, passive drowning, silent drowning, witnessed and unwitnessed, immersion, submersion, death certificate records drowning, unintentional submersion, road traffic injury leading to passenger vehicle drowning, drowning, near drowning, salt or freshwater drowning, and cold water drowning.
CONCLUSIONS
In the literature, a lack of consensus was observed but the following terms should not be abandoned; "Non-fatal drowning" which is used to describe death following rescue and life with at least 24 hours of in-hospital survival and the development of one or more complications and "Fatal drowning" which implies death occurring at the scene or 24 h of a submersion incident.
Topics: Humans; Drowning; Systematic Reviews as Topic; Water; Near Drowning; Fresh Water
PubMed: 37302005
DOI: 10.5249/jivr.v15i2.1816 -
Forensic Science, Medicine, and... Dec 2019This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26-27, 2018 at the...
Inconsistent classification of unexplained sudden deaths in infants and children hinders surveillance, prevention and research: recommendations from The 3rd International Congress on Sudden Infant and Child Death.
This report details the proceedings and conclusions from the 3rd International Congress on Unexplained Deaths in Infants and Children, held November 26-27, 2018 at the Radcliffe Institute at Harvard University. The Congress was motivated by the increasing rejection of the diagnosis Sudden Infant Death Syndrome (SIDS) in the medical examiner community, leading to falsely depressed reported SIDS rates and undermining the validity and reliability of the diagnosis, which remains a leading cause of infant and child mortality. We describe the diagnostic shift away from SIDS and the practical issues contributing to it. The Congress was attended by major figures and opinion leaders in this area from countries significantly engaged in this problem. Four categories (International Classification of Diseases (ICD)-11 categories of MH11, MH12, MH14, PB00-PB0Z) were recommended for classification, and explicit definitions and guidance were provided for death certifiers. SIDS was reframed as unexplained sudden death in infancy or SIDS/MH11 to emphasize that either term signifies the lack of explanation following a rigorous investigation. A distinct category for children over the age of 1 was recommended (MH12). Definitions and exclusions were provided for the alternative categories of accidental asphyxia and undetermined. As recommended, unexplained sudden death in infancy or SIDS on a death certificate will code a unique, trackable entity, accurately reflecting the inability to determine a definitive explanation, while satisfying surveillance needs and reliable identification for research efforts. The conclusions will be submitted to the World Health Organization for inclusion in the upcoming ICD-11.
Topics: Accidents; Asphyxia; Bedding and Linens; Child; Death, Sudden; Forensic Medicine; Humans; Infant; International Classification of Diseases; Sudden Infant Death; Terminology as Topic
PubMed: 31502215
DOI: 10.1007/s12024-019-00156-9 -
Anesthesiology Jun 2009
Topics: Accidents, Occupational; Drowning; Electric Injuries; History, 20th Century; Humans; Oxygen; Resuscitation; Ventilators, Mechanical
PubMed: 19461295
DOI: 10.1097/01.anes.0000352146.11672.1f -
Current Pediatric Reviews 2016Sudden infant death syndrome (SIDS) and other sleep-related infant deaths, such as accidental suffocation and strangulation in bed and ill-defined deaths, account for... (Review)
Review
Sudden infant death syndrome (SIDS) and other sleep-related infant deaths, such as accidental suffocation and strangulation in bed and ill-defined deaths, account for >4000 deaths annually in the USA. Evidence-based recommendations for reducing the risk of sleep-related deaths have been published, but some caregivers resist adoption of these recommendations. Multiple interventions to change infant sleep-related practices of parents and professionals have been implemented. In this review, we will discuss illustrative examples of safe infant sleep interventions and evidence of their effectiveness. Facilitators of and barriers to change, as well as the limitations of the data currently available for these interventions, will be considered.
Topics: Bedding and Linens; Caregivers; Cause of Death; Evidence-Based Medicine; Health Behavior; Health Education; Humans; Infant; Infant Mortality; Safety; Sleep; Sudden Infant Death
PubMed: 26496723
DOI: 10.2174/1573396311666151026110148 -
Neurocritical Care Dec 2012Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning... (Review)
Review
Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.
Topics: Asphyxia; Critical Care; Emergency Medical Services; Heart Arrest; Humans; Near Drowning; Resuscitation
PubMed: 22956050
DOI: 10.1007/s12028-012-9747-4 -
Drug and Alcohol Dependence Mar 2020Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by...
BACKGROUND
Opiate misuse has reached epidemic levels. Prevention efforts depend on distinguishing opiate users from abusers. The current study compared opioid users who died by natural cases, accidents, and suicide using psychological autopsy methods. Groups were compared on substance use characteristics, treatment history, experiences of negative life events, and circumstances at the time of death.
METHODS
Substance use and suicide risk were evaluated using psychological autopsy methods in 63 decedents with positive toxicology for opiates at death divided into three groups: adults dying by suicide (n = 19), accident (n = 19), and natural causes (n = 25). Groups were compared on several dependent measures, using chi-square analyses to examine categorical variables and one-way analyses of variance (ANOVA) to examine continuous variables.
RESULTS
Individuals who died by suicide were similar in many ways to adults who died by an accidental overdose. However, suicide completers were more likely to have struggled with severe depression, and previously attempted suicide, whereas the accidental overdose sample was more likely to display a chronic pattern of severe drug abuse.
CONCLUSIONS
The current study helps to distinguish between opiate users who are at risk for death by an accidental or intentional overdose. In the ongoing opiate crisis, clinicians must understand the risk of overdose and the nuances of accidental behaviors compared to purposeful ones. Signs of suicidal planning, relevant psychopathology, and ongoing life stress may be useful points of intervention for stopping the increasing number of deaths among opiate users.
Topics: Accidents; Adult; Aged; Autopsy; Cause of Death; Female; Humans; Male; Middle Aged; Opiate Alkaloids; Opiate Overdose; Opioid-Related Disorders; Risk Factors; Stress, Psychological; Suicide; Young Adult
PubMed: 31951908
DOI: 10.1016/j.drugalcdep.2020.107847 -
Clinics (Sao Paulo, Brazil) Sep 2012The objective of this study was to review mortality from external causes (accidental injury) in children and adolescents in systematically selected journals. This was a... (Review)
Review
The objective of this study was to review mortality from external causes (accidental injury) in children and adolescents in systematically selected journals. This was a systematic review of the literature on mortality from accidental injury in children and adolescents. We searched the Pubrvled, Latin-American and Caribbean Health Sciences and Excerpta Medica databases for articles published between July of 2001 and June of 2011. National data from official agencies, retrieved by manual searches, were also reviewed. We reviewed 15 journal articles, the 2011 edition of a National Safety Council publication and 2010 statistical data from the Brazilian National Ministry of Health Mortality Database. Most published data were related to high-income countries. Mortality from accidental injury was highest among children less than 1 year of age. Accidental threats to breathing (non-drowning threats) constituted the leading cause of death among this age group in the published articles. Across the pediatric age group in the surveyed studies, traffic accidents were the leading cause of death, followed by accidental drowning and submersion. Traffic accidents constitute the leading external cause of accidental death among children in the countries understudy. However, infants were vulnerable to external causes, particularly to accidental non-drowning threats to breathing, and this age group had the highest mortality rates for external causes. Actions to reduce such events are suggested. Further studies investigating the occurrence of accidental deaths in low-income countries are needed to improve the understanding of these preventable events.
Topics: Accidents; Adolescent; Age Distribution; Cause of Death; Child; Humans; Multiple Trauma; Risk Factors; Wounds and Injuries
PubMed: 23018311
DOI: 10.6061/clinics/2012(09)20