Medi̇colegal evaluati̇on of drowni̇ng cases whose autopsi̇es performed in Antalya, in ten years peri̇od between 2009-2018

According to mortality rate statistics in Turkish Republic, accidental deaths and natural deaths are top two most common causes of deaths, respectively. In our country, approximately 1000 people die each year as a result of drowning in water. Although drowning is preventable, it is among the leading causes of fatal accidents worldwide. In this study, 7775 cases that underwent medicolegal death examination and autopsied in the Morgue Department of Antalya Group Administration of Forensic Medicine Council, between the dates of 01.01.2009 and 31.12.2018 were analyzed, retrospectively. The reports and documents of 692 cases (8.9%) that were died as a result of drowning were investigated in terms of sociodemographic characteristics and findings. According to the data obtained in the study, while the ratio of men / women in drowning cases was approximately 4 (553/139; M: 79.9%, F: 20.1%), the average age of men was found to be 41.7 (SD ± 23.9), the average age of women was found to be 48.6 (SD ± 26.3). It was observed that the most of the cases were aged 60 and over (n: 223, 32.2%). It was determined that accidents were the most common manner of death (n: 655, 94.7%). Three-hundred-seventy-one patients (53.6%) were citizens of Turkish Republic, whereas, 320 patients (56.3%) were foreigners. It was observed that the majority of foreign nationals were Russian citizens (n: 123, 17.8%). It was determined that drownings most frequently occurred in summer (n: 321, 46.4%), in August (n: 120, 17.3%), and on Sunday (n: 118, 17.1%). It was recorded that 145 (20.9%) of the cases had a known history of chronic diseases. Deaths as a result of drowning were mostly seen in sea (n: 421, 60.9%), rivers (n: 76, 11.0%), swimming pools (n: 62, 9.0%) and canals (n: 40, 5.8%). There were clothes produced for water sports in 479 (69.2%) cases and daily clothes were found in 201 (29.1%) cases. It was found that 454 (65.6%) cases died at the scene, 6 (0.9%) patients died in the ambulance, and 232 (33.5%) patients died in a hospital. It was shown that 69 (10%) patients were treated in the intensive care unit. Livor mortis was detected in 678 (98%) cases, rigor mortis had been developed in 673 (97.3%) cases, 81 (11.7%) cases had goose skin appearance, 208 (30.1%) cases had washerwoman's skin appearance. It was found that 38 (5.5%) cases had decomposition findings, 548 (79.2%) of cases had the finding of mushroom-like froth, 311 (44.9%) had external traumatic findings, and 22 (3.1%) had foreign bodies in the respiratory tract. Water was found in the digestive system in 171 (24.7%) of cases. It was found that the mean weight of the right lung was 722.5 g (SD ± 281.5) and the mean weight of the left lung was 640.4 g (SD ± 155.9). Patients under 18 years of age were also evaluated in detail and it was determined that a total of 138 cases (20%) were in this group. For cases between the ages of 0-1 (infancy), the average weight of the right lung was 96.2 g, the average weight of the left lung was 91.5 g. Between the ages of 2-3 (early childhood), the average weight of the right lung was 190.8 g, average weight of the right lung was 240.2 g. Between the ages of 4-6 (preschool period) average weight of the right lung was 254.4 g, average weight of the right lung was 227.6 g. Between the ages of 7-12 (primary school), the average weight of the right lung is 347.4 g, the average weight of the left lung is 308.1 g. Between the age of 13-15 (secondary school), the average weight of the right lung is 586.3 g, the average weight of the left lung is 535, 8 gr. Between the ages of 16-18 (high school), the average weight of the right lung was 779.2 g, and the average weight of the left lung was 723.5 g. It was recorded that 39 (28.3%) of the children had at least one parent with them while incident was happen, whereas 99 (71.7%) of cases did not under supervisions of adults, neither parents, nor other relatives. The manner of death was reported as accident for 135 (97.8%) children (male: 107, female: 30), and as suicide for 3 (2.2%) children (male: 1, female: 2). It was determined that 18 out of 47 of accident cases were in the 13-18 age group and they went to places such as sea, river, lake or dam with their friends without an adult supervision. Only one of them was a girl and the rest were boys. The toxicological analysis results of 307 cases (44.3%) were positive. According to the toxicological analysis results; Ethyl alcohol/Methyl alcohol was detected in the blood of 108 (15.6%) cases, and narcotic/stimulant substance was detected in 66 (9.5%) cases. Significant histopathological findings were detected in 37 (5.3%) cases that died as a result of drowning. It was observed that the cause of death in 637 (92.1%) cases was drowning in water, and in 55 (7.9%) cases the cause was the combined effect of drowning and other causes. It has been determined that accidents are in the first place with a rate of 94.7% (n = 655) as manner of death. The diagnosis of drowning should be made by evaluating all of the deceased's health and psychosocial conditions, crime scene investigation reports and images, detailed autopsy and laboratory examination, and examination of other forensic investigation documents. To prevent drowning, which is an important public health problem, precautions such as organizing swimming courses for adults and children who cannot swim, assigning sufficient number of lifeguards at beaches, taking necessary warnings and precautions, increasing precautions in dams and lakes, fencing and barricades around water wells, irrigation pools, water channels and rivers, appropriate lighting around irrigation canals and rivers passing through settlements, building safety barriers around swimming pools to prevent children or alcoholics from falling, and not letting children, elderly with chronic diseases or epileptics, and those who drink alcohol or use drugs that affect the central nervous system to swim alone in the sea or pool, should be taken. Keywords: Forensic medicine, drowning, autopsy