Back hemorrhage in bath-related deaths: Insights into the mechanism of bath-related deaths

Oshima, Toru; Ohtani, Maki; Mimasaka, Sohtaro

doi:10.1016/j.forsciint.2020.110146

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…In the majority of cases, the degree of heat‐induced orthostatic hypotension observed in the present study was a harmless event, yet the manifestation of dizziness and impaired postural control is an important finding because this might lead to a transient window of increased risk of falls (Johansson et al., 2017 ). Indeed, analysis of autopsies after bath‐related deaths has identified orthostatic hypotension upon standing as the most likely cause of falls and mortality (Oshima et al., 2020 ). Based on such findings, we urge caution before longer bathing durations and higher temperatures of water immersion when unsupervised without effective mitigations.…”

Section: Discussionmentioning

confidence: 99%

The effect of age and mitigation strategies during hot water immersion on orthostatic intolerance and thermal stress

Steward

Menzies

Clarke

et al. 2023

Experimental Physiology

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Hot water immersion improves cardiovascular health and sporting performance, yet its adverse responses are understudied. Thirteen young and 17 middle-aged adults (n = 30) were exposed to 2 × 30 min bouts of whole-body 39 • C water immersion.Young adults also completed cooling mitigation strategies in a randomized crossover design. Orthostatic intolerance and selected physiological, perceptual, postural and cognitive responses were assessed. Orthostatic hypotension occurred in 94% of middle-aged adults and 77% of young adults. Young adults exhibited greater dizziness upon standing (young subjects, 3 out of 10 arbitrary units (AU) vs. middle-aged subjects, 2 out of 10 AU), with four terminating the protocol early owing to dizziness or discomfort. Despite middle-aged adults being largely asymptomatic, both age groups had transient impairments in postural sway after immersion (P < 0.05), but no change in cognitive function (P = 0.58). Middle-aged adults reported lower thermal sensation, higher thermal comfort, and higher basic affect than young adults (all P < 0.01).Cooling mitigation trials had 100% completion rates, with improvements in sit-tostand dizziness (P < 0.01, arms in, 3 out of 10 AU vs. arms out, 2 out of 10 AU vs. fan, 4 out 10 AU), lower thermal sensation (P = 0.04), higher thermal comfort (P < 0.01) and higher basic affect (P = 0.02). Middle-aged adults were predominantly asymptomatic, and cooling strategies prevented severe dizziness and thermal intolerance in younger adults.

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Section: Discussionmentioning

confidence: 99%

The effect of age and mitigation strategies during hot water immersion on orthostatic intolerance and thermal stress

Steward

Menzies

Clarke

et al. 2023

Experimental Physiology

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“…However, there was no significant difference in the frequency of intramuscular hemorrhage or the number of muscles with hemorrhage in freshwater drownings compared to seawater drownings. On the other hand, in the study by Oshima et al [ 22 , 27 ], although no statistical analysis was performed, the frequency of intramuscular hemorrhage was similar in the sea, rivers, and ditch/ irrigation channels, with the highest frequency in ponds and the lowest in bathtubs. Bath-related drowning in Japan may be caused by loss of consciousness due to prior endogenous diseases such as arrhythmia caused by temperature change, cardiovascular disease, and the development of cerebrovascular disease [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 86%

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

et al. 2021

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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.

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“…Additionally, Oshima T's study drew attention to the manifestation of subcutaneous back hemorrhages without accompanying muscular hemorrhages around the scapula -an identifiable autopsy sign seen in bathtub-related deaths. The study highlighted orthostatic hypotension upon exiting the bathtub as a potential instigator of this distinctive marker [29]. These studies emphasize the critical need for additional specific diagnostic indicators to accurately determine the cause of death in bathtub-related deaths.…”

Section: Postmortem Evidence Analysismentioning

confidence: 86%

Unveiling Lethal Risks Lurking in Hot Tub Baths: A Review of Tragic Consequences

Dahiya,

Asif,

Santhi

et al. 2024

Cureus

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Heat therapy, including saunas, jacuzzi, and hot tub bathing, has gained global popularity. However, the escalating incidents of injuries and fatalities associated with hot tub activities are a significant public health concern. This study aims to comprehensively review and analyze the pathophysiological factors contributing to hot tub-related deaths, addressing the need for awareness and mitigation strategies. A comprehensive search of electronic databases, PubMed and Science Direct, was conducted to identify articles relevant to bath-related deaths. Eligible studies were exported to the Rayyan (Qatar Computing Research Institute, Qatar) software for data analysis. The data extracted from the 18 studies were compiled to elucidate the mechanisms underlying hot tub bath-related deaths and to advocate for the adoption of potential mitigation strategies and future directions to prevent such incidents in the future. The review revealed insights into the current trend of fatalities linked to hot tub bathing. A detailed analysis of pathophysiological aspects, encompassing hemodynamics, electrolyte disturbances, serum glucagon alterations, and the impact of alcohol and substance abuse during hot tub use, was conducted. Furthermore, we explored the effects of temperature and conducted a thorough discussion of postmortem evidence analysis concerning deaths related to bathtub usage. Finally, the paper discusses mitigation strategies to prevent fatalities attributed to hot tub bathing. In conclusion, our review highlights growing public health concerns surrounding injuries and fatalities related to hot tub activities. Through an examination of the incidence rates, pathophysiological factors, and proposed mitigation strategies, we provide crucial insights for enhancing safety and addressing the escalating risks associated with hot tub bathing.

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Back hemorrhage in bath-related deaths: Insights into the mechanism of bath-related deaths

Cited by 8 publications

References 12 publications

The effect of age and mitigation strategies during hot water immersion on orthostatic intolerance and thermal stress

The effect of age and mitigation strategies during hot water immersion on orthostatic intolerance and thermal stress

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

Unveiling Lethal Risks Lurking in Hot Tub Baths: A Review of Tragic Consequences

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