Division of Forensic Medicine, National Forensic Service, Seoul, Korea.
Medical Examiner's Office, National Forensic Service, Wonju, Korea.
J Korean Med Sci. 2018 Apr 2;33(14):e108. doi: 10.3346/jkms.2018.33.e108.
The diagnostic criteria for bathtub drownings are not standardized, and the risk factors associated with bath-related deaths are unclear.
We analyzed a Korean nationwide database of bath-related deaths that occurred between January 2008 and December 2015. Eighty-four cases were enrolled after reviewing 31,123 autopsy records.
The subjects' ages ranged from 18 to 91 years, with a mean age ± standard deviation of 61.3 ± 16.0 years. Bath-related deaths in the winter were approximately 4.6-fold greater than those in the summer. Of the 84 subjects, the primary cause of death in 57 (67.9%) was drowning in the bath; 24 (28.6%) drowned of other causes such as natural diseases, and 3 (3.6%) died of acute alcohol intoxication. We analyzed water-inhalation signs to establish criteria for bathtub drowning diagnosis. There were significantly higher incidences of hyperinflated lungs, water in the sphenoid sinus and stomach/duodenal contents, and Paltauf's spots (subpleural hemorrhage) in bathtub-drowned subjects compared to non-drowned individuals (P < 0.01). Multiple signs of water inhalation were significantly associated with bathtub drowning (P < 0.01). The two leading contributory causes of bath-related death were cardiovascular diseases and alcohol intoxication (binge drinking before bathing).
The diagnosis of bath-related deaths could present considerable medico-legal problems; therefore, a comprehensive autopsy with a thorough scene investigation can clarify the cause of death in these situations. Preventive strategies for reducing such deaths should target alcohol drinking before bathing and long soaking times in bathtubs, especially among elderly individuals with preexisting cardiovascular diseases.
浴缸溺水的诊断标准尚未标准化，与浴盆相关死亡相关的危险因素也不清楚。
我们分析了 2008 年 1 月至 2015 年 12 月期间韩国全国范围内与浴盆相关的死亡数据库。在审查了 31123 份尸检记录后，共纳入了 84 例病例。
研究对象的年龄为 18 至 91 岁，平均年龄±标准差为 61.3±16.0 岁。冬季与浴盆相关的死亡人数约为夏季的 4.6 倍。在 84 名受试者中，57 名（67.9%）的主要死因是在浴缸中溺水；24 名（28.6%）因自然疾病等其他原因溺水，3 名（3.6%）死于急性酒精中毒。我们分析了水吸入的迹象，以建立浴缸溺水诊断标准。与非溺水者相比，在浴缸溺水者中，肺部过度充气、蝶窦和胃/十二指肠内容物有水、Paltauf 斑（胸膜下出血）的发生率明显更高（P<0.01）。水吸入的多个迹象与浴缸溺水明显相关（P<0.01）。导致浴盆相关死亡的两个主要原因是心血管疾病和酒精中毒（洗澡前狂饮）。
浴缸相关死亡的诊断可能会带来相当大的法律问题；因此，全面的尸检和彻底的现场调查可以澄清这些情况下的死因。减少此类死亡的预防策略应针对洗澡前饮酒和长时间浸泡在浴缸中，尤其是针对患有心血管疾病的老年人群。
