Weight ratio of the lungs and pleural effusion to the spleen in the diagnosis of drowning

Nishitani, Yoko; Fujii, Kenichi; Okazaki, Shunichiro; Imabayashi, Kiyomi; Matsumoto, Hiroshi

doi:10.1016/j.legalmed.2005.08.001

Cited by 22 publications

(9 citation statements)

References 22 publications

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“…The DI was first defined by Nishitani et al as the weight ratio of the lungs and pleural effusion fluid to the spleen in an attempt to identify a quantitative measurement that could be used to diagnose drowning at autopsy (9). The utility of the DI appears to rest primarily on the findings of frothy fluid in the airways and increased lung weight, which are typically associated with drowning but are less common in cases of Drowning Index = ([Lungs (g)+Pleural Effusion (g)]) (Spleen (g)) Equation 1: Formula for calculation of drowning index.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have attempted to identify patterns in organ weights that may be distinctive for drowning. Nishitani et al defined the drowning index (DI) as the weight ratio of the lungs and pleural effusion fluid to the spleen and suggested that it may be useful in differentiating drowning deaths from other asphyxial deaths (9). Sugimura et al found that a DI of greater than 14.1 is highly specific for drowning when compared to mechanical asphyxia and death due to acute cardiac failure (10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Application of the Drowning Index to Opioid & Multidrug Intoxication Deaths: A Retrospective Analysis

Ellis¹,

Opsahl²,

Duff³

et al. 2019

Academic Forensic Pathology

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Introduction: Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many nondrowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index (DI) has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. Studies have suggested DI may be useful in confirming drowning as the cause of death. No studies have yet compared autopsy findings in drownings to those in drug-related deaths, in spite of their qualitative similarities. Materials and Methods: We compared the lung and pleural effusion weight, spleen weight, and DI from 536 autopsies ruled drowning, opioid, or multidrug intoxication, or hanging in Columbia, Missouri, from 2011 to 2016. Results: Opioid overdoses result in heavier lungs and spleens than drownings, multidrug overdoses, or hangings. There is no DI value at which a death can be definitively ascribed to drowning. The median DI was significantly higher in drownings than in opioid intoxications, multidrug intoxications, or hangings ( P < .0001; P = .001; P = .005). However, very few drowning cases (13.33%) had a DI >14.1. Additionally, many opioid and multidrug overdoses had a DI >14.1. The highest calculated DI value (DI = 33) was associated with multidrug intoxication. Conclusion: In our opinion, the DI has little, if any, utility in distinguishing between drowning and drug-related deaths.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of the Drowning Index to Opioid & Multidrug Intoxication Deaths: A Retrospective Analysis

Ellis¹,

Opsahl²,

Duff³

et al. 2019

Academic Forensic Pathology

View full text Add to dashboard Cite

show abstract

“…47 Similarly, reference values for postmortem lung weights are not available for most breeds of animals and application of allometrically determined lung weights 43,79 require further validation if applied in a forensic context. A drowning index of the weight ratio of the lungs and pleural effusion to the spleen has been proposed in humans to be more accurate than absolute lung weights, 61 although it is affected by postmortem interval and has a relatively low sensitivity and specificity of 66% and 77.5% respectively. 80 It remains to be determined if this measurement is accurate or applicable to animals.…”

Section: Lung Weightsmentioning

confidence: 99%

Veterinary Forensic Pathology

McEwen

Gerdin²

2016

Vet Pathol

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Determining the cause of death in animals recovered from bodies of water, swimming pools, or other water-containing vessels is challenging. Animals recovered from water may or may not have drowned. The diagnosis of drowning is usually one of exclusion, requiring information from the crime scene, recovery scene, the medical history or reliable witness accounts. While there are characteristic macroscopic and microscopic lesions of drowning, none are specific and are dependent on the volume and tonicity of the drowning medium. Beyond interpreting the postmortem findings, the court may ask pathologists to comment on the behavioral and welfare implications of drowning. This requires an understanding of the drowning process, which is a complex series of sequential, concurrent, and overlapping cardiorespiratory reflexes, electrolyte and blood gas abnormalities, aspiration, physical exhaustion, and breathlessness eventually culminating in death. This review addresses the mechanisms, lesions, and diagnostic issues associated with drowning in nonaquatic companion animals.

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“…Instead, extensive pleural effusion is often observed in the thoracic cavity, and this finding is applied to the diagnosis of drowning since victims of drowning are assumed to have inhaled a large amount of water and the water exudes into the thoracic cavity due to postmortem changes [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Application of electrolyte analysis of pleural effusion to diagnosis of drowning

et al. 2012

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We measured concentrations of sodium (Na), chloride (Cl), calcium (Ca), and magnesium (Mg) in pleural effusion from forensic autopsy cases to examine whether they were useful for a diagnosis of drowning. We analyzed a total of 51 cases (15 seawater drowning, 10 freshwater drowning, and 26 non-drowning), and determined the following reference values. If the concentration of Na or Cl is under 65 mEq/l, a diagnosis of freshwater drowning can be made. If the concentration of Na is higher than 175 mEq/l, or that of Cl is higher than 155 mEq/l, or that of Ca is higher than 16 mg/dl, or that of Mg is higher than 15 mg/dl, a diagnosis of seawater drowning can be made. We recommend that pleural effusion from the left and the right thoracic cavities should be collected and analyzed separately because large differences may be observed between each side in the case of drowning. If one side corresponds to the reference value for seawater or freshwater drowning and the other side does not, a diagnosis of drowning can still be made according to the obtained value.

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Weight ratio of the lungs and pleural effusion to the spleen in the diagnosis of drowning

Cited by 22 publications

References 22 publications

Application of the Drowning Index to Opioid & Multidrug Intoxication Deaths: A Retrospective Analysis

Application of the Drowning Index to Opioid & Multidrug Intoxication Deaths: A Retrospective Analysis

Veterinary Forensic Pathology

Application of electrolyte analysis of pleural effusion to diagnosis of drowning

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