Postmortem characteristics of drowning death in freshwater: a systematic review

Abstract

BACKGROUND: Drowning is the third leading cause of death by unintentional injury, accounting for 7% of all injury-related deaths worldwide. According to the latest World Health Organization Global Health Estimates, 236,000 people died from drowning in 2019. AIM: This systematic review aimed to examine the clinical, laboratory, and other postmortem characteristics associated with death from drowning in freshwater areas. MATERIALS AND METHODS: A systematic search of PubMed, Epistemonikos, and Cochrane Library databases was performed with no restrictions to find relevant articles. After the removal of duplicates, articles were reviewed, and information on the clinical, laboratory, and other postmortem characteristics of freshwater drowning deaths was extracted. RESULTS: Of the 493 articles, 73 papers were considered relevant for full-text review. Of these, 22 articles met the inclusion criteria for the review. Most drowning deaths occurred in freshwater. Victims were males, with a male-to-female ratio of 8:3. External and internal clinical characteristics that are widely reported included signs of asphyxia such as cyanosis of the lips and bilateral fingernails, immersion signs such as washerwoman’s hand, pink teeth, Neil’s sign, Svechnikov’s sign, Wydler’s sign, and debris in the airways, and typical drowning signs such as froth in the airway, emphysema aquosum, and Paltauf spot. CONCLUSION: The results of this study suggest that the presence of signs of asphyxia, immersion signs, and typical drowning signs such as froth in the airway, emphysema aquosum, and Paltauf spots were associated with drowning deaths in freshwater.