Decomposed and non-decomposed bodies retrieved from water: a comparative approach

Evaluation of coding ill-defined and unknown causes of death in the Republic of Serbia

One of the most frequently used indicators for the quality of mortality statistics is the use of R-codes as the cause of death (COD) in death certificates. The aim of this study was to analyse the coding of ill-defined and unknown causes of death in the Republic of Serbia (RS). The data for this descriptive study, covering a ten-year period (2006-2015), were obtained from the National Mortality Register. Since population and economic features differ widely between regions in RS, we compared the Belgrade region (BR) with other regions (Or). We estimated the frequency of certain types of death investigation methods regarding R00-99-coded deaths. The frequency of R-codes, by subcategories, and code-specific mortality rates were calculated by region for each year. The use of R-codes was significantly lower in BR than in Or (OR 0.85; 95% CI, 0.84-0.66; p < 0.001). The most frequent method of determining COD was external examination of the body, both in BR and Or (60.7% and 85.5%, respectively). The rate of forensic autopsies in BR was 38.1% while in Or it was only 3.6%. Clinical autopsies were performed in 1% of deaths in BR, compared to 0.5% in Or. Our results suggest that in BR the use of R-codes compared to other CODs has decreased over the past years while there has been an increasing trend in autopsy proportions; in Or the frequency of R-codes, as well as of autopsy proportions, has remained unchanged.

Decomposition Changes in Bodies Recovered from Water

Recovering bodies from water is a common task for any medical examiner or coroner office. Unfortunately, there will be a significant postmortem interval before many of these remains are found. A thorough scene investigation must be undertaken to determine if the location of the death and that of the body recovery are the same. Decomposition in a wet environment differs from that in other settings, both in the changes that occur and the rate at which they occur. It is essential that the forensic pathologist or medicolegal death investigator recognize and appreciate the uniqueness of immersed and submerged remains. The typical decomposition changes proceed more slowly in the water, primarily due to cooler temperatures and the anaerobic environment. However, once a body is removed from the water, putrefaction will likely be accelerated. Postmortem changes are not only affected by water temperature, but also by current as well as obstacles and structures, both natural and man-made, that may interact with the remains. The anaerobic nature of decomposition for wet or submerged remains may result in adipocere formation, a unique and fascinating process that results from incomplete transformation of lipids by bacteria. Insect and animal species feeding on the remains are different for submerged bodies. Postmortem predation may cause external defects that mimic injuries and should be interpreted with care. Forensic pathologists and medicolegal death investigators must be aware of the postmortem changes that may occur with submerged and immersed bodies.

Drowning in Pretoria, South Africa: A 10-year review

Drowning is classified as the 3rd leading cause of accidental deaths worldwide and is deemed to be a preventable cause of death. Bodies retrieved from a water medium pose several challenges to the forensic pathologist with the diagnosis of drowning being primarily one of exclusion. The aim of this study was to do a retrospective descriptive case audit of bodies retrieved from water and immersion related deaths, which were investigated at the Pretoria Medico-Legal Laboratory (PMLL) over a 10 year period (January 2002 through December 2011). A total of 346 cases were identified for inclusion into this study. In 6% (20) of these cases, the death was not related to drowning; in 14% (48) no clear cause of death could be ascertained and in 278 cases (80%) the cause of death was considered to have been due to drowning. Infants (under 1 year, of age) constituted 41 (15%) of the cases; toddlers (aged 1-2 years) comprised 52 (19%) cases; children (aged 2-13 years) 49 (18%) cases; adolescents (aged 13-18 years) comprised 10 (3%) cases; adults (above 18, years) made up 126 (45%) of the cases. The majority of the drownings, occurred in swimming pools [125 cases (38%)]. In infants 23 (56%) of, drownings occurred in swimming pools followed by buckets [7 cases (17%)]. Sixty-nine per cent of toddler drownings (36 cases) occurred in swimming, pools. In the adult population, 40 (32%) of cases occurred in pools and 35 cases (28%) in rivers. Positive blood alcohol results were recorded in 48, (42%) out of 113 cases where the test was requested, 40 (35%) of these, cases higher than 0.05 g per 100 ml. This study suggests that many drowning deaths in Pretoria may be preventable by introducing greater public awareness of the risks and instituting relatively simple, protective measures.