Bath-related Deaths in Korea between 2008–2015

Abstract

BackgroundThe diagnostic criteria for bathtub drownings are not standardized, and the risk factors associated with bath-related deaths are unclear.MethodsWe analyzed a Korean nationwide database of bath-related deaths that occurred between January 2008 and December 2015. Eighty-four cases were enrolled after reviewing 31,123 autopsy records.ResultsThe subjects' ages ranged from 18 to 91 years, with a mean age ± standard deviation of 61.3 ± 16.0 years. Bath-related deaths in the winter were approximately 4.6-fold greater than those in the summer. Of the 84 subjects, the primary cause of death in 57 (67.9%) was drowning in the bath; 24 (28.6%) drowned of other causes such as natural diseases, and 3 (3.6%) died of acute alcohol intoxication. We analyzed water-inhalation signs to establish criteria for bathtub drowning diagnosis. There were significantly higher incidences of hyperinflated lungs, water in the sphenoid sinus and stomach/duodenal contents, and Paltauf's spots (subpleural hemorrhage) in bathtub-drowned subjects compared to non-drowned individuals (P < 0.01). Multiple signs of water inhalation were significantly associated with bathtub drowning (P < 0.01). The two leading contributory causes of bath-related death were cardiovascular diseases and alcohol intoxication (binge drinking before bathing).ConclusionThe diagnosis of bath-related deaths could present considerable medico-legal problems; therefore, a comprehensive autopsy with a thorough scene investigation can clarify the cause of death in these situations. Preventive strategies for reducing such deaths should target alcohol drinking before bathing and long soaking times in bathtubs, especially among elderly individuals with preexisting cardiovascular diseases.

Characteristics and outcomes of public bath-related out-of-hospital cardiac arrests in South Korea

“…A previous report suggests that the uniqueness of bath-related OHCAs could be the higher body temperature immediately after cardiac arrest. 12 In our study, almost all the patients suffering from cardiac arrest were found in warm baths and the saunas. Hyperthermia is associated with an unfavorable neurologic recovery after cardiac arrest.…”

“…As the authors mentioned in their report, the autopsy rate in South Korea is extremely low, and autopsy is performed only when necessary. 12 Our study revealed that the rate of bystander witnessed cardiac arrest in PBs was very low despite being in a public place. A previous study indicated that the bath-related OHCAs were less likely to be witnessed by bystanders (6.4% in home baths and 17.6% in PBs).…”

“…Bath-related cardiac arrests were more likely to increase owing to the high popularity of Yung Jae Yoo, et al PB and spas (Jjimjilbang) as well as the recent rapidly growing elderly population. 12 Therefore, our study could enable the development of preventive strategies and management guidelines in PBrelated cardiac arrest. In our study, several characteristics differed between PB-related cardiac arrest patients and the non-PB cardiac arrest patients.…”

“…1). A total of 27,106 patients, including 12,363 patients with non-cardiac origin arrest (12,363), obvious irreversible death (7,652), CPR refusal (3,820), aborted CPR (1,344), arrest in ambulance (939), age under 18 years or pregnant (421), do-not-resuscitate (359), and incomplete data (208) were excluded from the final analysis. Of those patients who met the inclusion criteria, 263 (2.2%) cardiac arrests occurred in the PB (PB group) while 11,626 (97.8%) occurred in other places (non-PB group).…”

“…No investigations of bath-related out-of-hospital cardiac arrest (OHCA) have been conducted in South Korea, except for one retrospective study, which described the cause and characteristics of bath-related deaths at autopsy. 12 Although some previous studies have demonstrated that the outcomes of bath-related OHCA patients were poor, few compared the outcomes of cardiac arrest to other locations. 4,5 Recently, a Smart Advanced Life Support (SALS) pilot project was introduced in some areas in South Korea, where in the event of a cardiac arrest, the nearest two units of emergency medical services (EMS) are dispatched, and under the directives of an emergency physician, the paramedics could use a manual defibrillator, administer drugs, and perform advanced life support.…”