DIAGNOSIS OF DROWNING, AN EVERLASTING CHALLENGE IN FORENSIC MEDICINE: REVIEW OF THE LITERATURE AND PROPOSAL OF A DIAGNOSTIC ALGORITHM

Gian Luca MareLLa1, aLessandro FeoLa2, LuiGi Tonino MarseLLa2, siLvesTro MaurieLLo2, PasquaLe GiuGLiano3, Giovanni

arcudi4

1Department of Surgical Sciences, University of Rome “Tor Vergata”, via Montpellier 1, Rome, Italy - 2Department of Biomed- icine and Prevention, University of Rome “Tor Vergata”, via Montpellier 1, Rome, Italy - 3Section of Legal Medicine, A.O.R.N. “Sant’Anna e San Sebastiano”, via Palasciano, Caserta, Italy - 4Catholic University “Our Lady of Good Counsel”, Dritan Hoxha Street, Tirana, Albania

 Introduction: The diagnosis of drowning is one of the major challenges in the field of forensic medicine and usually it is a “di- agnosis of exclusion.” Traditionally, the post-mortem diagnosis of drowning is based on the combination in one diagnosis both the alterations, caused by the type of asphyxia, and those due to the thanatological changes, caused by the duration of the corpse in water. Due to the development of technologies in forensic sciences this approach results actually obsolete. The purpose of this study was to design and propose an algorithm that diagnoses drowning.

Materials and method: A review of the papers published in forensic pathology literature was performed using multiple combi- nations of search terms were used to select scientific research about drowning on PubMed.

Conclusion: The methodology used up to now, which was based on external and internal findings, is not very effective, bring- ing together in one analysis the alterations in the body depending on the type of asphyxia and the thanatological expression of the permanence of the corpse in water. The technological evolution in the medicolegal field has, therefore, encouraged us to use more sophisticated investigations by assigning the diagnosis not only according to autopsy finding. The algorithm we propose has the pur- pose of guaranteeing a diagnosis based on uniform criteria that contribute to formulating a diagnosis of drowning that is reliable and coherent, while using the available survey tools.