Muscular hemorrhages around the scapula resulting from excessive upper extremity motion in cases of fatal drowning: autopsy findings for insights on manner of death

Oshima, Toru; Ohtani, Maki; Mimasaka, Sohtaro

doi:10.1016/j.forsciint.2019.04.029

Cited by 11 publications

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“…When the manner of drowning deaths was tracked down among all 85 cases in this study, the majority of cases was found to be accidental with 81 cases out of 85, whereas both suicidal and homicidal cases reported only 2 cases for each of them. Several studies held by Oshima et al ( 40 ), Cenderadewi et al ( 15 ), Chang and Smith ( 41 ) and Xu ( 42 ) found out that accidental drowning incidents had the highest percentage of occurrence compared to other modes of death as homicide and suicide.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological Analysis of Drowning Deaths Among Different Groups in Jordan - a Retrospective Study (2015-2019)

Shotar¹,

Halalsheh²,

Shatnawi³

et al. 2022

Med Arch

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Background: According to the World Health Organization (WHO), drowning is globally considered as one of the leading causes of injury related deaths. Defined as the process of experiencing respiratory impairment from submersion in a liquid medium. Drowning is a public health concern in Jordan. This study aimed to investigate drowning incident data from the Forensic Medicine Teaching Centre in the North of Jordan for the purpose of defining high risk groups and circumstances around drowning fatalities which suffered an attention deficit. Objective: The study aims to describe the rate of fatal drowning in North of Jordan and to properly understand the risk factors associated with it. Methods: The present study is retrospective, based on investigating 2808 autopsy reports and selecting only 85 drowning related death reports conducted through a 5 year period (2015-2019) in the Forensic Medicine Teaching Centre which serves Northern Jordan including Irbid, Jarash, Ajloun, and Al-Mafraq. The statistical analysis of fatal drowning cases included the following risk variables: Age, gender, month, year, nationality, address, alcohol and drug consumption. Results: 15 variables were consistent and analyzed across the database of this study. The high risk groups and patterns were identified and the majority of fatal drowning cases were related to males (80.4%). Age group from (2 to 27 years of age were included in the high-risk groups with (88.2%) of all cases. Specifically, the age 2 had the highest occurring frequency. While (17.6%) of drowning fatalities occurred in August. Alcohol and drugs had no significant impact on increasing drowning rates. The dominant manner of death among all cases was accidental (95.3%). Fatal drowning rates were decreasing throughout the years of (2015-2019). Conclusion: Defining drowning high risk groups and its epidemiology helps to overcome this preventable cause of death. The current study highlights the necessity for the need of further interventions to be actively fixed into policies and educational programs and emphasize safety precautions during water activities and to improve the dataset collection for better planning of prevention strategies.

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Section: Discussionmentioning

confidence: 99%

Epidemiological Analysis of Drowning Deaths Among Different Groups in Jordan - a Retrospective Study (2015-2019)

Shotar¹,

Halalsheh²,

Shatnawi³

et al. 2022

Med Arch

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“…Therefore, as described in detail in the previous paragraph, the repeated contraction and relaxation of muscles due to spasmodic dyspnea resulting from the drowning process, agonal convulsions, or "struggling" to avoid drowning may cause injury to muscles in elderly drowning cases. In the study by Oshima et al [ 22 ], the reported frequency of intramuscular hemorrhage was significantly higher (63.4%) than that in any other study, possibly due to the large proportion of elderly subjects (median age, 73 years; range in age, 3 to 97 years). It should be noted that the mean age of the subjects in the present study was <65 years (mean age, 60.8 years; median age, 64.0 years; range in age, 4 to 89 years).…”

Section: Discussionmentioning

confidence: 71%

“…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: 87%

“…Püschel et al [ 21 ] found that 51.3% (20 out of 39) of drowning cases showed hemorrhage in respiratory and accessory respiratory muscles, as well as other back and upper extremity muscles, suggesting that such hemorrhage may be caused not only by spasmodic dyspnea, but also by systemic convulsions during the agonal stage in the process of asphyxiation or by "struggling" to avoid drowning. Recently, Oshima et al [ 22 ] reported that 63.4% (104 out of 164) of drowning cases showed hemorrhage in the muscles around the scapula (supraspinatus, infraspinatus, and rhomboid muscles), and that agonal convulsions may not cause such hemorrhage, but by intentional violent movement of the upper limbs in the act of struggling to avoid drowning (self-rescue attempts). In the present study, intramuscular hemorrhage was observed in 31.7% (46 out of 145) of the drowning cases, but it was limited to the respiratory and accessory respiratory muscles of the neck and chest.…”

Section: Discussionmentioning

confidence: 99%

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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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“…2 These hemorrhages were not observed in individuals who had a fatal disease before drowning or in those with cervical injures. 2 We speculated that the absence of muscular hemorrhages around the scapula in these cases was due to unconsciousness or paralysis preventing upper extremity movement. Therefore, we considered these muscular hemorrhages to be "findings," and not "injuries," which resulted from upper extremity motion during the process of drowning (not from agonal convulsions).…”

Section: Discussionmentioning

confidence: 95%

Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia

Oshima¹,

Ohtani

Mimasaka

2021

Am J Forensic Med Pathol

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Muscular hemorrhages around the scapula that are caused by upper extremity motion are rarely reported in cases other than drowning. We examined differences in the frequency of muscular hemorrhages around the scapula and stratified them by the cause of death. Muscular hemorrhages were mostly noted in cases of drowning (118/185, 63.8%), followed by cases of asphyxia (23/44, 52.3%). In addition, muscular hemorrhages around the scapula were found in cases of ligature strangulation (8/11, 72.7%), manual strangulation (2/3, 66.7%), choking (11/14, 78.6%), and traumatic asphyxia (2/2, 100%). Muscular hemorrhages were not found in cases of hanging or environmental suffocation, possibly because of the short time interval preceding the loss of consciousness. The distribution of muscular hemorrhages was similar in choking and drowning cases. Muscular hemorrhages due to strangulation were mainly unilateral, whereas those due to choking and drowning were mainly bilateral. During all types of asphyxia, muscular hemorrhages around the scapula were considered to be the result of conscious, active upper extremity motion. Because the frequency and laterality of muscular hemorrhages around the scapula differed based on the type of asphyxia, our findings provide insights into the manner of asphyxia that could be used to aid in the identification of homicidal hangings.

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Muscular hemorrhages around the scapula resulting from excessive upper extremity motion in cases of fatal drowning: autopsy findings for insights on manner of death

Cited by 11 publications

References 5 publications

Epidemiological Analysis of Drowning Deaths Among Different Groups in Jordan - a Retrospective Study (2015-2019)

Epidemiological Analysis of Drowning Deaths Among Different Groups in Jordan - a Retrospective Study (2015-2019)

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

Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia

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