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. The latest World Health Organization Global Health Estimates estimate that 236,000 people died from drowning in 2019. Objective: This study used a systematic review to examine the clinical, laboratory, and other postmortem characteristics associated with death from drowning in freshwater areas. Method: A systematic search of PubMed, Epistemonikos, and Cochrane Library databases was performed with no restrictions to find relevant literature. After removal of duplicates, articles were reviewed, and information on clinical, laboratory, and other postmortem characteristics of freshwater drowning deaths was extracted. Result: Of 493 articles found, 73 papers were considered relevant for full-text review. Of these, 22 articles met the inclusion criteria for the review. Most of the drowning deaths occurred in fresh water and only one case was described as a drowning in a freshwater area. Victims were male, with a male-to-female ratio of 8:3. External clinical characteristics that were found only in the freshwater drowning case were washerwoman's hand and pink teeth. Internal clinical findings unique to the freshwater drowning case were debris in the airways and Neil’s sign. Conclusion: Our study suggests that washerwoman's hand, pink teeth, debris in airways, and Neil’s sign are associated with drowning death in freshwater areas.