ABSTRACT
Drowning is a diagnosis of exclusion based on circumstantial and autopsy correlation. Sugimura proposed a threshold value of 14.1 for the Drowning Index (DI), the ratio of lung and pleural fluid to spleen weight, as a surrogate marker to diagnose drowning. We questioned the use of DI in diagnosing drowning. We compared DI between three groups--drowning, mechanical asphyxia, and myocardial infarct--seen at Broward MEO from 2008 to 2009. Only 9.4% of 53 drownings exceeded the DI threshold of 14.1, while 30% of 10 mechanical asphyxias and 40% of 10 myocardial infarcts had DI >14.1. Sensitivity for the DI test was <10% and specificity 60-70%. Median DI values for all groups were <10. Mann-Whitney U-test was not statistically significant between groups. The DI is neither sensitive nor specific and lacks any utility in the diagnosis of drowning.
Subject(s)
Asphyxia/diagnosis , Drowning/diagnosis , Lung/pathology , Myocardial Infarction/diagnosis , Pleural Effusion/pathology , Spleen/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Forensic Pathology/methods , Humans , Male , Middle Aged , Organ Size , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Statistics, NonparametricABSTRACT
Determination of the time of death is one goal of medicolegal death investigations. Algor mortis has been used as a measure of the postmortem interval (PMI). We prospectively recorded the core temperatures of 19 adult bodies entering our morgue cooler and at 3, 6, and 9 h of refrigeration. We then compared the cooling rate with the calculated body mass index (BMI). For each individual body, the rate of cooling was fairly linear with no evidence of a plateau. There was fair to moderate correlation between the BMI and the cooling rate: cooling rate = -0.052 (BMI) + 3.52. The probability of linearity in any given case was 36%. Variables affecting this correlation included the presence and the layers of clothing and if the clothing was wet. Our data confirm that algor mortis is of very limited utility in determining the PMI in bodies that have been refrigerated.
