title: "Dead in hot bathtub" phenomenon: accidental drowning or natural disease?
abstract: Sudden death in a hot bathtub occurs frequently in Japan, particularly among elderly people. This retrospective report describes the epidemiologic circumstances and physical findings at autopsy. In total, 268 victims were found unconscious or dead during tub bathing. After postmortem examination, the manner of death was judged as natural cause in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Mean age (SD) was 72.1 (15.2) years with no significant difference between males and females. A seasonal difference was evident: the winter displayed the highest frequency. Drowning water inhalation, which was confirmed in 72% of victims, was absent in the others. The most common observations on postmortem examination were cardiac ischemic changes and cardiomegaly. Water inhalation signs were evident in a significantly fewer victims exhibiting these factors. In contrast, inhalational findings were observed more frequently in victims with other backgrounds such as alcohol intake, mobility disturbance, and history of epilepsy. Annual mortality in Japan from accidental drowning in persons aged older than 75 years is 33 deaths per 100,000 population. However, this number may be considerably underestimated as pathologists tend to regard lack of water inhalation as indicating a natural cause of death. Confusion in diagnosis remains consequent to the accidental and natural aspects of "dead in hot bathtub" phenomenon.
authors: Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
authors: Fumiko
authors: F
authors: Satoh
authors: Motoki
authors: M
authors: Osawa
authors: Iwao
authors: I
authors: Hasegawa
authors: Yoshihisa
authors: Y
authors: Seto
authors: Akio
authors: A
authors: Tsuboi
mesh_terms: D000059:Accidents / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000032:analysis; D001494:Baths / Q000009:adverse effects*; D006332:Cardiomegaly / Q000473:pathology; D002492:Central Nervous System Depressants / Q000032:analysis; D002648:Child; D003645:Death, Sudden / Q000453:epidemiology*; D004332:Drowning / Q000175:diagnosis* / Q000401:mortality; D062787:Drug Overdose; D000431:Ethanol / Q000032:analysis; D005260:Female; D049429:Forensic Pathology; D006331:Heart Diseases / Q000473:pathology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000473:pathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology; D053120:Respiratory Aspiration / Q000473:pathology; D012189:Retrospective Studies; D012621:Seasons; D012640:Seizures / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D002492:Central Nervous System Depressants; D000431:Ethanol