Dataset Information

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases.

ABSTRACT: The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiological characteristics of 145 cases diagnosed as drowning, in which hemorrhage, not due to trauma, was found in the respiratory muscles and accessory respiratory muscles. Hemorrhage was observed in 31.7% of these cases, and the incidence did not differ by gender or drowning location. The frequency of hemorrhage was significantly higher in months with a mean temperature below 20°C than in months above 20°C, suggesting a relationship between the occurrence of hemorrhage and low environmental temperature. Moreover, the frequency of hemorrhage was significantly higher in the elderly (aged ≥65 years) compared to those <65 years old. In the elderly, the weakening of muscles due to aging may contribute to the susceptibility for intramuscular hemorrhage. Moreover, these intramuscular hemorrhages do not need to be considered in cases of a potential bleeding tendency due to disease such as cirrhosis or medication such as anticoagulants. Our results indicate that intramuscular hemorrhage in respiratory and accessory respiratory muscles can serve as an additional criterion to differentiate between fatal drowning and other causes of death, as long as no cutaneous or subcutaneous hematomas above the muscles with hemorrhages are observed. In addition, the epidemiological features that such intramuscular hemorrhage is more common in cold environments and in the elderly may provide useful information for the differentiation.

SUBMITTER: Onitsuka D

PROVIDER: S-EPMC8699964 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases.

Onitsuka Daiko D Nakamae Takuma T Katsuyama Midori M Miyamoto Machiko M Higo Eri E Yatsushiro Masahiko M Hayashi Takahito T

PloS one 20211223 12

The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiol ...[more]

PMID: 34941921

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Project description:ObjectivesThe epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning.DesignA subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare's National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates.SettingAustralia, 1 July 2002 to 30 June 2015.ParticipantsUnintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation.Results2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0-4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65-74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal.ConclusionsThis study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

Project description:BackgroundEffective interventions to reduce drowning incidents require accurate and reliable data for scientific analysis. However, the lack of high-quality evidence and the variability in drowning terminology, definitions, and outcomes present significant challenges in assessing studies to inform drowning guidelines. Many drowning reports use inappropriate classifications for drowning incidents, which significantly contributes to the underreporting of drowning. In particular, non-fatal drowning incidents are underreported because many countries do not routinely collect this data.The danish drowning cohortThe Danish Drowning Cohort was established in 2016 to facilitate research to improve preventative, rescue, and treatment interventions to reduce the incidence, mortality, and morbidity of drowning. The Danish Drowning Cohort contains nationwide data on all fatal and non-fatal drowning incidents treated by the Danish Emergency Medical Services. Data are extracted from the Danish prehospital electronic medical record using a text-search algorithm (Danish Drowning Formula) and a manual validation process. The WHO definition of drowning, supported by the clarification statement for non-fatal drowning, is used as the case definition to identify drowning. All drowning patients are included, including unwitnessed incidents, non-conveyed patients, patients declared dead prehospital, or patients with obvious clinical signs of irreversible death. This method allows syndromic surveillance and monitors a nationwide cohort of fatal and non-fatal drowning incidents in near-real time to inform future prevention strategies. The Danish Drowning Cohort complies with the Utstein style for drowning reporting guidelines. The 30-day mortality is obtained through the Civil Personal Register to differentiate between fatal and non-fatal drowning incidents. In addition to prehospital data, new data linkages with other Danish registries via the patient's civil registration number will enable the examination of various additional factors associated with drowning risk.ConclusionThe Danish Drowning Cohort contains nationwide prehospital data on all fatal and non-fatal drowning incidents treated by the Danish Emergency Medical Service. It is a basis for all research on drowning in Denmark and may improve preventative, rescue, and treatment interventions to reduce the incidence, mortality, and morbidity of drowning.

Dataset Information

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases.

Publications

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases.

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