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PubMed2002

Suicide by drowning: a 20-year review.

Drowning as a method of suicide is known to occur, but has primarily been described in environments with readily available access to water, such as coastal regions. In this study, we describe and analyze a series of suicidal drownings occurring in a noncoastal area of Texas. Between 1977 and 1996, 52 cases of suicidal drowning were investigated at the Southwestern Institute of Forensic Sciences in Dallas, Texas. Such deaths accounted for only 0.85% of all suicides and 4% of all drowning deaths. In contrast. suicidal drownings reportedly account for 2.8 to 8.9% of all suicides in regions with easy access to water. As with other studies of suicidal drowning, the victims are usually sober white males over the age of 40 years. Our results also confirm that certain individuals who commit suicide by drowning use weights to facilitate the process. A detailed analysis of the cases is provided. as is a synopsis of several questions that may aid in determining the manner of death in suicidal drowning cases.

Adult↗
PubMed1990

The usefulness of lung surfactant phospholipids (LSPs) in the diagnosis of drowning.

The authors have studied the usefulness of some lung surfactant phospholipids (LSPs) isolated from lung tissues as markers of drowning. Two different groups of rabbits were sacrificed by drowning in fresh and salt water, and their phospholipid compositions were compared with those of a non-drowned control series. For the phospholipids studied in lung lavages (phosphatidyl choline, phosphatidyl ethanolamine, and phosphatidyl glycerol) the proportions differed between the control group and the drowned group, and between the fresh-water and salt-water drowned animals. According to these results, the lipids we have analyzed can be employed as markers in forensic autopsies, where it is necessary to differentiate between death by drowning and postmortem immersion and between fresh-water and salt-water drowning. In lung tissue, only phosphatidyl choline and phosphatidyl inositol showed significative differences. These results also confirm that LSPs are strongly affected in drowning.

Animals↗
PubMedDate not supplied

Drowning in Alaskan waters.

OBJECTIVE: To enumerate drowning fatalities in Alaska in order to identify risk factors and areas for intervention. METHODS: Information from death certificates, state troopers' reports, and medical examiner reports were abstracted and analyzed. Rates were calculated using 1990 census figures as denominator data. RESULTS: There were 542 drowning fatalities in Alaska for the years 1988 to 1992. The 20-29 age group had the highest frequency and rate of drownings. The incidence rate for the state was 20 drownings per 100,000 population per year, almost 10 times higher than the overall U.S. rate of 2.11 per 100,000 per year. Incidence rates were highest among adolescent males (10-19), young adult males (20-29). Alaska Natives, and rural residents. Alaska Native males, ages 30-39 averaged 159 drownings per 100,000 per year, the highest drowning rates in the state. CONCLUSIONS: Drowning is a major public health concern in Alaska. People who fish commercially and young Native males are groups at high risk for drowning. Intervention efforts should be concentrated on these two populations.

Adolescent↗
PubMed1998

Diagnosis of drowning by combined computer-assisted histomorphometry of lungs with blood strontium determination.

The aim of our study was to examine the combined contribution of computer-assisted histomorphometry of lungs with blood strontium (BS) measurement to the diagnosis of drowning in cadavers recovered from fresh water. The study population comprised 116 drowned subjects. The results for this group were compared with those obtained for three non-drowned groups: 22 subjects who died from causes other than asphyxia, 13 subjects who died of asphyxia (strangulation or hanging); and 23 healthy living subjects in whom normal BS level was measured. Samples of water where the bodies had been found were analyzed in order to establish a relation with the BS concentration of the drowned subjects. Histologically, each type of pulmonary lesion (congestion, edema, alveolar macrophages, alveolar hemorrhage, and emphysema aquosum) was evaluated semiquantitatively using a score according to the severity of the pathology. Then, a quantitative histomorphometric study was performed using a computer-assisted image analyzer to measure the length and thickness of the alveolar walls, and the area and density of the alveolar cavities. The mean values of the BS levels in the 116 drowned subjects and of the water strontium concentrations were found to be much higher than in the living individuals. Although the ranges were wide, we found no overlap between values found in drowned subjects and those in non-drowned subjects. Emphysema aquosum and to a lesser extent alveolar hemorrhage were found to be the most significant histologic changes in the drowned and asphyxia groups compared with the nonasphyxia control groups.

Drowning↗
PubMed2000

Blood strontium concentration related to the length of the agonal period in seawater drowning cases.

The levels of ventricular blood strontium (Sr) from 70 seawater drowning victims were compared with their diagnosis of drowning based mainly on certain criteria selected from their autopsy report. From this comparison, intervals of either the difference of Sr concentration between the left and the right ventricle blood (LVSr-RVSr) or the Sr concentration in the left ventricle blood (LVSr), appear to be related to different time-lapses of the agonal period of drowning. In the aim to diagnose drownings, intervals of both LVSr-RVSr and LVSr were proposed to characterize three different agonal periods in seawater drowning cases: instantaneous death (ID), fast vital-submersion drowning (FVSD) and common vital-submersion drowning (CVSD).

Diagnosis, Differential↗
PubMed2000

A sandwich enzyme immunoassay for pulmonary surfactant protein D and measurement of its blood levels in drowning victims.

A sensitive sandwich enzyme immunoassay for human pulmonary surfactant protein D (SP-D) was developed and used to examine the blood SP-D levels of drowning victims. Human SP-D was purified from amniotic fluid by chromatographic methods, and an antibody against human SP-D was prepared. A polystyrene ball coated with anti-SP-D IgG was incubated with purified human SP-D, and then with anti-SP-D Fab'-peroxidase conjugate. Peroxidase activity bound to the polystyrene ball was assayed by fluorometry using 3-(4-hydroxyphenyl)propionic acid as the hydrogen donor. The detection limit of human SP-D was 5.2 pg per assay tube. Examination of cross-reactions of this sandwich enzyme immunoassay with proteins from other human organs showed it to be highly specific for lung, and Northern blot analysis detected specific SP-D mRNA expression only in lung. The SP-D concentration of normal human serum was 6.4+/-2.7 (mean+/-S.D.) ng ml(-1) (n=20). The recovery rates of 0.52 ng and 5.2 ng SP-D added to 5 microl normal human serum were 93.6+/-2.7% and 93.6+/-6.1%, respectively. Blood SP-D levels of victims from the saltwater drowning group (n=14) revealed higher concentrations (105.8+/-53.7 ng ml(-1)), while freshwater drowning victims (n=12) were estimated to be 74.1+/-43.9 ng ml(-1). The SP-D levels of 15 subjects who died of hemorrhage (n=5), heart failure (n=8), traumatic shock (n=1), and electrocution (n=1) were lower (22.0+/-8.5 ng ml(-1)), and those of asphyxia victims (n=10) were slightly higher (36.2+/-17.1 ng ml(-1)) than those of other causes of death, except for drowning. These results suggest that in drowning victims, SP-D flowed into the systemic circulation by physiological and physical mechanisms, and the differences of blood SP-D levels between saltwater drowning and freshwater drowning victims are presumed to be influenced by the type of agony and/or the length of survival time in water.

Adolescent↗
PubMed2003

Phytoplankton gene detection in drowned rabbits.

We have developed a sensitive and specific polymerase chain reaction (PCR) method for identifying phytoplankton in cases of death by drowning, and we have designed four primer pairs, EG1, EG2, SK1 and SK2, for chlorophyll-related genes of Euglena gracilis and Skeletonema costatum, which are commonly distributed in all types of water. In order to evaluate the usefulness of this method for diagnosis of drowning, we have used this method for detection of plankton genes in non-drowned rabbits submerged after death and in decomposed drowned rabbits. Plankton DNA was identified in lung samples obtained from the non-drowned rabbits because of postmortem plankton penetration into the respiratory system, and plankton DNA was identified in liver and kidney samples obtained from the decomposed drown rabbits. The results show that our new PCR method is a useful method for diagnosing drowning.

Adult↗
PubMed2003

Possible postmortem serum markers for differentiation between fresh-, saltwater drowning and acute cardiac death: a preliminary investigation.

The aim of the present study was to investigate the differences in postmortem blood biochemistry between fresh-, saltwater drowning and acute myocardial infarction/ischemia (AMI) (n=11, n=15 and n=23, respectively; postmortem interval <48 h). Left and right cardiac blood samples were examined for the serum markers: sodium (Na), chloride (Cl), magnesium (Mg), blood urea nitrogen (BUN), creatinine (Cr), pulmonary surfactant-associated protein A (SP-A) and cardiac troponin T (cTn-T). The most efficient markers were the left-right cardiac BUN ratio for determination of drowning (hemodilution) and the left heart blood Mg level for differentiation between fresh- and saltwater aspiration. A characteristic feature of saltwater drowning was a low left-right BUN ratio and a marked elevation in the serum Cl, Mg and Ca levels of the left heart blood. Serum cTn-T level was usually low in drownings, showing a difference from most cases of AMI. Freshwater drowning showed a significant elevation of serum SP-A, although there was considerable overlapping with saltwater drowning and AMI. These findings suggested the usefulness of serum markers in the investigation of death from drownings.

Acute Disease↗
PubMed2003

Postmortem lung weight in drownings: a comparison with acute asphyxiation and cardiac death.

There are several controversial findings and arguments about the lung weight as a marker of drowning. The aim of the present study was to examine the difference in the lung weight and the amount of pleural effusion between freshwater and saltwater drownings (n=70 and n=75, respectively), in comparison with asphyxiation (n=85) and acute cardiac death (n=82), for the diagnosis of drowning. In drowning cases, a gradual postmortem time-dependent decrease in the lung weight and a reciprocal increase in the pleural effusion suggested postmortem transudation from the lungs. The decrease in the total value of the combined lung weight and the amount of pleural effusion was marked in saltwater immersion after 3 days postmortem, suggesting a leakage of the effusion out of the thoracic cavity under an osmotic effect of the immersion medium. In cases within 3 days postmortem, when the combined lung weight and amount of pleural effusion were added to estimate possible combined lung weight at the time of death, there was a gross difference among the causes of death: the value was the largest in saltwater drowning, followed by freshwater drowning, acute cardiac death and asphyxiation. However, the value depended on the gender and age of the subjects, suggesting a relation to the individual physical constitution and survival time or vital activity. These factors should be taken into consideration in evaluation of the lung weight in the diagnosis of drownings.

Adult↗
PubMed1997

Pneumonia associated with near-drowning.

Drowning and near-drowning can abruptly devastate the lives of both the affected victims and their families. In addition to the complications directly caused by the submersion, several indirect causes of morbidity exist. Infection is one of the complications associated with near-drowning, and pneumonia is the most severe of these infectious complications. The risk factors, microbiological causes, diagnostic approach, and appropriate therapy for pneumonia associated with near-drowning are not well described in the literature. Herein, we review the epidemiology and pathophysiology associated with near-drowning, discuss the potential mechanisms of infection, and describe the likely risk factors for pneumonia related to near-drowning. We also detail the microbiological causes of this entity and provide important clinical and epidemiological information associated with specific pathogens. Finally, we summarize an appropriate diagnostic and therapeutic approach to pneumonia associated with near-drowning.

Adult↗
PubMed2005

Usual water-related behaviour and 'near-drowning' incidents in young adults.

OBJECTIVE: To describe usual water-related behaviour and 'near-drowning' incidents in a cohort of young New Zealand adults. METHOD: This was a cross-sectional study based on data collected as part of the Dunedin Multidisciplinary Health and Development Study, which is the study of a cohort (n = 1,037) born between 1 April 1972 and 31 March 1973 in Dunedin, New Zealand. The data analysed were collected at age 21 (1993/94). Each study member was given a face-to-face interview using a structured questionnaire. RESULTS: Males reported a higher level of water confidence, exposure to risk behaviours, and exposure to unsafe locations, and more 'near-drowning' incidents, than the females, but protective behaviour did not differ. Males and females who were 'confident' in the water were more likely to be exposed to unsafe water locations, and water-confident males were more likely to drink alcohol before water activities, but not boating. A total of 169 'near-drowning' incidents were reported by 141 study members (63% males). 'Near-drowning' incidents were associated with unsafe swimming environments for males (p < 0.001) and boating within two hours of consuming alcohol for females (p = 0.002). CONCLUSIONS: This study described usual water-related behaviour and has provided preliminary evidence of the factors associated with 'near-drowning' incidents among a high-risk age group. Larger case-control studies are required to further investigate risk factors for 'near-drowning'. IMPLICATIONS FOR PRACTITIONERS: Further investigation is required to determine the effectiveness of providing water skills acquisition in both safe and unsafe environments on 'near-drowning' experience.

Adult↗
PubMed2003

Trends in childhood drowning on U.S. farms, 1986-1997.

Computerized mortality data files from the National Center for Health Statistics were analyzed to describe childhood farm drowning from 1986 through 1997. Farm drowning rates were compared to the U.S. unintentional youth drowning rates for the same period. The denominator for the calculation of rates was derived from a series of farm youth estimates published by the Bureau of Census. There were 378 childhood farm drowning cases during the study period, for an average annual rate of 2.3 deaths per 100,000 farm youth resident years. This rate is comparable to unintentional drowning rates for U.S. youth (2.2/100,000 population). Fatality rates declined 28% from 1986 through 1997 (p = .0024) for farm youth and 41% for U.S. youth (p = .0001). An average 32 farm drowning incidents occur to youth annually, making drowning a legitimate concern for farm residents and visitors.

Accidents↗
PubMed1998

Childhood drownings and fencing of outdoor pools in the United States, 1994.

OBJECTIVES: To determine the prevalence of proper fencing around outdoor swimming pools among US households and to describe this fencing in relation to demographic and other household factors. To estimate the number of drownings among children <5 years of age that might be prevented by having proper fencing around all residential pools in the United States. METHODS: A 1994, randomly dialed national telephone survey contacted 5238 adults who reported demographic information and household characteristics including whether the household had an outdoor swimming pool and the fencing around the pool. Data were weighted to obtain national estimates and percentages. The number of preventable drownings was estimated with a population-attributable risk equation. RESULTS: Approximately 18.5 million American households owned or had access to an outdoor swimming pool in 1994, and 76% (13.9 million) of them appeared to have had adequate fencing. Adequate fencing was associated with household income and type of home. We estimate that 19% of pool-related drownings among children <5 years of age in 1994 (88 drownings) might have been prevented if all residential pools in the United States were properly fenced. CONCLUSIONS: Adequate pool fencing prevents a child from having access to a swimming pool if a responsible adult is not present and has been promoted as a method to prevent drowning. Our research suggests that even if all residential pools in the United States were properly fenced, most drownings among children <5 years of age would not be prevented. Thus, additional strategies to prevent drowning will be needed.

Accident Prevention↗
PubMed1990

Drownings in Minnesota, 1980-85: a population-based study.

We conducted a population-based study of drownings in Minnesota from 1980 through 1985. Five hundred and forty-one drownings (2.1 per 100,000 person-years) were identified from death certificates and from incident reports filed with the Minnesota Department of Natural Resources. Most drownings (334, 62 percent) occurred during summer months (May-August) and involved boating (42 percent) and swimming (35 percent) events. However, 62 drownings (11 percent) occurred during winter months (December-February) and primarily involved snowmobiles and motor vehicles (71 percent) breaking through ice on lakes and waterways. The risk of drowning, estimated by the ratio of drownings to number of water-related activities, was highest during March and April, when the ice on lakes and waterway surfaces is melting, and during October and November, when lake and waterway surfaces are starting to freeze. Drowning rates were highest for males (3.7 per 100,000 person-years), persons 15 to 25 years of age (3.3 per 100,000 person-years), and children less than 5 years of age (2.5 per 100,000 person-years). These data can be used to target prevention strategies, particularly in northern climates.

Adolescent↗
PubMed2000

Effects of pool-fencing ordinances and other factors on childhood drowning in Los Angeles County, 1990-1995.

OBJECTIVES: This study estimated the effects of local pool-fencing ordinances and other factors on the rate of childhood drowning in Los Angeles County, California. METHODS: Stage 1 was a retrospective dynamic cohort study of all drownings among children younger than 10 years that occurred in residential swimming pools in Los Angeles County between 1990 and 1995. Stage 2 was a matched case-control study that compared pools in which childhood drownings occurred (cases) with randomly selected pools in which drownings did not occur (controls). RESULTS: The drowning rate was relatively high among toddlers (aged 1-4 years), boys, and African Americans and in areas with a high density of residential swimming pools. Pool-fencing ordinances were not associated with a reduced overall rate of childhood drowning. CONCLUSIONS: Local ordinances enacted in Los Angeles County before 1996 do not appear to have been effective in reducing the rate of childhood drowning in residential pools. Possible reasons for this ineffectiveness are insufficient building codes for isolating pools from homes, inadequate enforcement of the ordinances, and inadequate operation or maintenance of fencing equipment by pool owners.

Age Distribution↗
PubMed1999

Drowning among personal watercraft passengers: the ability of personal flotation devices to preserve life on Arkansas waterways, 1994-1997.

Personal flotation devices (PFD) are promoted and in many states are required for safe boating practices and to prevent drowning. Primary use of PFDs is associated with water sports (water skiing, tubing, etc.), boating and other water activities. Their purpose is to preserve life and prevent drowning. However, their effectiveness to prevent drowning and near-drowning has not been well established. The purpose of this investigation was to determine the effectiveness of PFDs to prevent drowning and near-drowning of individuals involved in personal watercraft (PWC) crashes. Methods include the 48-month collection of PWC crash data from the Arkansas Game and Fish Commission for 1994-1997. Information on PFD use, swimming experience, whether passengers were ejected from the watercraft and crash cause was queried. Results show that 38% were not swimmers, 98% wore a PFD and 54% were ejected from the PWC. Alcohol was a causal factor in six crashes and one death. It is estimated that PFDs saved 38 Arkansans who could have drowned. This study highlights one example of the effectiveness of PFDs to prevent mortality and morbidity.

Accidents↗
PubMed2003

[Evaluation on intervening efficacy of health education on accidental suffocation and drowning of children aged 0 - 4 in countryside].

OBJECTIVE: The main causes of death in children aged 0 - 4 were accidental suffocation and drowning which had a significant relation with parents' lack of prevention knowledge and effective measures. By comparing parents' acknowledge and behavior in preventing accidental suffocation and drowning and the mortality rate of accidental suffocation and drowning after intervening with those before the intervening, evaluation was made on intervening efficacy of health education. METHODS: Six counties in north Jiangsu were involved in the survey. Two townships drawn from each county were divided into the intervened group and the controlled group. Health education was carried out in the intervened group for one year in 2000. Twenty to 30 parents of infants and children aged 1 - 4 drawn randomly from every township in the intervened group were taken as investigation subjects before and after intervening, and a questionnaire was made for them to answer. Meanwhile, the mortality rates of accidental suffocation and drowning were measured. RESULTS: Followed by health education for a year, the parents' opinion about whether unintentional injury can be avoided or not has changed from 18.8% to 20.5% to 1.8% - 2.9%, and parents' knowledge about how to give first aid in spot has increased from 11.1% - 13.5% to 41.1% - 56.8%. The parents' behavior that not sleeping with their infants in the same beds and not tying infants in a candle with blanket, and setting up fence beside pools and rivers has increased by 75.7%, 61.5% and 61.2%, respectively, while their relative knowledge has increased by 212.7% and 194.3%. In the intervened group, the mortality rates of infants' accidental suffocation per 100,000 has fallen from 487.8 to 71.2, dropped by 85.4%; and the mortality rates of drowning in children aged 1 - 4 per 100,000 has fallen from 60.0 to 36.2, dropped by 39.7%. In comparison, in the controlled group, the mortality rates of infants' accidental suffocation per 100,000 has fallen from 344.1 to 276.4, dropped by 19.7%; and the mortality rates of drowning in children aged 1 - 4 per 100,000 has increased by 26.3%, from 51.7 to 65.3. CONCLUSION: Health education to parents is an effective intervening measure for prevention of accidental suffocation and drowning. The goal of health education should be to change inadequate behavior and dangerous environment in which unintentional injury is easily happened. The intervening measures that not sleeping with their infants in the same beds and not tying infants in a candle with blanket, and putting up fence beside pools and rivers are feasible and practicable.

Accident Prevention↗
PubMed1990

Drownings in Florida 1977-1986.

Drowning is a serious public health problem in Florida. It is the leading cause of death among children aged one to four years. We studied Florida drownings for 1977-1986 using data from the Florida vital statistics mortality file and found that 5,525 occurred, the greatest number in 1980 (688), the fewest in 1985 (453). The reasons for this decrease are not clear, but the greatest decrease occurred in swimming pool drownings. Nonwhite males had the highest overall drowning rates, except for those under age five or 80 and above. White males had the highest drowning rates for persons under age five; most of these occurred in swimming pools. No single approach will prevent drownings in all high risk groups. Priority should be given to foursided fencing of swimming pools and to further study of nonwhite male drownings.

Accidents, Home↗