Diagnosis of drowning, an everlasting challenge in forensic medicine: Review of the literature and proposal of a diagnostic algorithm

Introduction: The diagnosis of drowning is one of the major challenges in the field of forensic medicine and usually it is a “diagnosis 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 combinations 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, bringing 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 purpose 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.