Diagnosing fatal drownings: A review of the postmortem findings
Alexander Tyr, Nina Heldring, Carl Winskog, Brita Zilg
Abstract
The lack of drowning-specific pathological findings postmortem complicates medico-legal investigations when bodies are recovered in water. This review provides an in-depth analysis of macroscopic and microscopic findings, as well as biochemical and molecular approaches typically used to diagnose drownings. To ensure that only studies fulfilling established scientific criteria were selected to form conclusions in this review, existing literature was systematically assessed using SPICOT for evaluation of scientific evidence and risk of bias. Analysis of selected studies indicates that several pathophysiological findings following suspected drowning lack scientific evidence, while others are supported by the literature. However, the shortage of suitable controls in drowning research, specifically addressing non-drowned immersed bodies significantly limits investigations on postmortem drowning pathology, and further research is warranted. • Diagnosing drowning as a cause of death remains challenging. • This systematic review covers research & recommendations for diagnosis of drowning. • Diagnosis should consider macro/microscopic findings & circumstantial evidence. • Future research requires non-drowned immersed controls.