The role of paranasal sinus fluid in determining drowning as the cause of death: A systematic review and meta-analysis

• Published in: Journal of forensic and legal medicine Vol. 99; p. 102591
• Main Authors: da Trindade, Rafael Queiroz, Duarte Morais Vieira, Maria Gabriela, Vieira, Raíssa Bastos, Vicentin-Junior, Carlos Antonio, Damascena, Nicole Prata, Santiago, Bianca Marques, Martins-Filho, Paulo Ricardo, Palhares Machado, Carlos Eduardo
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2023
• Subjects: Autopsy - methods; Cause of Death; Drowning; Drowning - diagnosis; Forensic medicine; Forensic sciences; Humans; Paranasal Sinuses; Pathology; Tomography; Tomography, X-Ray Computed - methods; X-ray computed; Tomography; Drowning; Forensic medicine; X-ray computed; Paranasal sinuses; Forensic sciences
• ISSN: 1752-928X; 1878-7487; 1878-7487
• DOI: 10.1016/j.jflm.2023.102591

Drowning is a significant global cause of unintentional injury fatalities, and accurate forensic diagnosis of drowning remains a challenge due to the nonspecific nature of post-mortem findings obtained through classical autopsy methods. Our manuscript addresses this issue by focusing on the emerging use of paranasal sinus fluid as a valuable tool in determining the cause of death, specifically in distinguishing drowning from non-drowning cases. The study provided a comprehensive summary of available evidence from observational studies that compared findings in the paranasal sinuses between drowning and non-drowning victims, analyzing parameters such as the presence of fluid, fluid volume, and density. The study encompassed a total of 14 selected studies involving 1044 subjects and utilized rigorous risk of bias assessment and data synthesis techniques. The meta-analysis demonstrated a strong association between the presence of fluid in the paranasal sinuses and drowning (OR = 17.1; 95% CI 7.2 to 40.5; p < 0.001). In addition, drowning victims had a significantly greater volume of fluid (SMD = 0.8; 95% CI 0.5 to 1.2; p < 0.001) and lower fluid density (SMD = −1.4; 95% −2.5 to −0.4; p = 0.008) compared to non-drowning cases. The results support the utility of paranasal sinus fluid analysis as a valuable diagnostic method in cases where drowning is suspected but cannot be definitively confirmed through traditional approaches. •The presence of fluid in these air-filled cavities can indicate water aspiration during drowning.•There is a strong association between fluid presence in the paranasal sinuses and drowning.•Drowning victims had more fluid in the sinuses and lower fluid density compared to non-drowning cases.•Fluid in the paranasal sinuses is valuable to distinguish between drowning and non-drowning cases in criminal investigations.