Lunetta Philippe, Penttila Antti, Sajantila Antti
Department of Forensic Medicine, University of Helsinki, Finland.
Am J Forensic Med Pathol. 2002 Dec;23(4):371-6. doi: 10.1097/00000433-200212000-00015.
The diagnosis of drowning relies primarily on critical examination of the subject's individual characteristics, circumstances, and postmortem macropathologic changes. In this retrospective study, based on 1590 consecutive cases of bodies found in water and undergoing autopsy at the Department of Forensic Medicine, University of Helsinki, from 1976 to 1998, the frequency of circumstantial data and macropathologic changes crucial for the diagnosis of drowning were determined. The fatal events were eyewitnessed in 403 cases (25.3%), and suicide notes were found in 83 cases (5.2%). External foam, frothy fluid in airways, and overlap of the anterior margins of lungs were found in 275 (17.3%), 739 (46.5%), and 669 (42.1%) of the cases, respectively, but no one of these changes, tested against dry-land controls, were specific for drowning. The association of external foam and overlap of the lung margins was exclusive of drowning but was observed in only 176 cases (11.1%). After cross-analysis, 964 (60.6%) of the cases had no circumstantial data or macromorphologic pathologic findings that allowed a definite diagnosis of drowning. The diagnostic problems in putative drowning cases, based on this study sample, have not been overrated. Studies to investigate and improve the reliability of complementary methods for the diagnosis of drowning are warranted.
溺水的诊断主要依赖于对受害者个体特征、事发情况以及死后大体病理变化的严格检查。在这项回顾性研究中，基于1976年至1998年期间在赫尔辛基大学法医学系连续1590例在水中发现并接受尸检的尸体案例，确定了对溺水诊断至关重要的相关情况数据和大体病理变化的出现频率。403例（25.3%）死亡事件有目击者，83例（5.2%）发现了遗书。分别在275例（17.3%）、739例（46.5%）和669例（42.1%）的案例中发现了体表泡沫、气道内泡沫状液体以及肺前缘重叠的情况，但是将这些变化与陆地对照样本进行对比后发现，没有一项变化对溺水具有特异性。体表泡沫和肺边缘重叠的关联并非溺水所特有，仅在176例（11.1%）案例中观察到。经过交叉分析，964例（60.6%）案例没有能够明确诊断溺水的相关情况数据或大体病理发现。基于本研究样本，疑似溺水案例中的诊断问题并未被高估。有必要开展研究以调查并提高溺水诊断补充方法的可靠性。
