title: The Drowning Index: implementation in drowning, mechanical asphyxia, and acute myocardial infarct cases.
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.
authors: Broward County Medical Examiner and Trauma Services, 5301 S.W. 31st Avenue, Fort Lauderdale, FL, 33312, USA.
authors: Khalil S
authors: KS
authors: Wardak
authors: Robert M
authors: RM
authors: Buchsbaum
authors: Frozan
authors: F
authors: Walyzada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001237:Asphyxia / Q000175:diagnosis*; D004332:Drowning / Q000175:diagnosis*; D005260:Female; D049429:Forensic Pathology / Q000379:methods; D006801:Humans; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009929:Organ Size; D010996:Pleural Effusion / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000473:pathology*; D018709:Statistics, Nonparametric
keywords: asphyxia; cause of death; drowning; drowning index; forensic science; myocardial infarct