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Published on: September 27, 2020
Effects of postmortem interval on postmortem computed tomography findings in bath-related drowning cases
Miho Yoshimatsu1, Hiroyuki Tokue1, Akiko Jingu1
1Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Japan.
Background And Objectives:
The influence of postmortem interval (PMI) on postmortem computed tomography (PMCT) findings in bath-related drowning remains unclear. This study aimed to identify PMI-susceptible and relatively stable PMCT findings.
Materials And Methods:
Seventy-seven bath-related drowning cases met the eligibility criteria. To minimize the potential influence of resuscitation-related artifacts, the primary analysis was performed in 72 cases after excluding five hospital-transported cardiopulmonary arrest cases with documented pre-PMCT resuscitative intervention. Quantitative PMCT findings were assessed using Spearman's rank correlation; Group A (PMI <24 h) and Group B (PMI ≥24 h) were compared using the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. Multivariable regression analyses adjusted for age and sex were also performed.
Results:
The sphenoid sinus-fluid volume, gastric-fluid volume, and ethmoid sinus-fluid accumulation showed no significant associations with the PMI after adjustment for age and sex. In contrast, the pleural effusion volume, anterior mediastinal distance, right diaphragm level, splenic attenuation, total stomach volume, and gastric-air volume remained significantly associated with the PMI after adjustment for age and sex. The association of maxillary sinus-fluid volume with the PMI in the univariable analysis lost significance after adjustment for age and sex.
Conclusion:
Within the range of PMI examined in this study, the sphenoid sinus-fluid volume, ethmoid sinus-fluid accumulation, and gastric-fluid volume showed no significant associations with the PMI after adjustment for age and sex and may represent relatively stable findings across different PMIs.
Insights
Postmortem computed tomography (PMCT) findings like sphenoid sinus fluid, ethmoid sinus fluid, and gastric fluid are stable across different postmortem intervals (PMI) in drowning cases. Other findings, however, change significantly with PMI.
Area of Science:
- Forensic pathology
- Radiology
- Medical imaging
Background:
- Postmortem interval (PMI) estimation is crucial in forensic investigations.
- The reliability of postmortem computed tomography (PMCT) findings for PMI determination in drowning cases requires further clarification.
Purpose of the Study:
- To identify postmortem computed tomography (PMCT) findings that are susceptible to changes with postmortem interval (PMI).
- To identify postmortem computed tomography (PMCT) findings that remain relatively stable across different postmortem intervals (PMI) in bath-related drowning cases.
Main Methods:
- Analysis of 72 bath-related drowning cases, excluding those with pre-PMCT resuscitation.
- Quantitative PMCT findings assessed using Spearman's rank correlation and Mann-Whitney U test.
- Multivariable regression analyses performed, adjusting for age and sex.
Main Results:
- Sphenoid sinus-fluid volume, gastric-fluid volume, and ethmoid sinus-fluid accumulation showed no significant PMI association after adjustment.
- Pleural effusion volume, anterior mediastinal distance, right diaphragm level, splenic attenuation, total stomach volume, and gastric-air volume were significantly associated with PMI.
- Maxillary sinus-fluid volume association with PMI lost significance after adjustment.
Conclusions:
- Sphenoid sinus-fluid volume, ethmoid sinus-fluid accumulation, and gastric-fluid volume are relatively stable PMCT findings across varying PMIs in drowning.
- These stable findings may aid in postmortem interval estimation in bath-related drowning cases.
- Other PMCT findings are susceptible to PMI changes and require careful interpretation.
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