Drowning incidents precipitated by unusual causes (DIPUCs): A narrative review of their diagnoses, evaluation and management

• Published in: Resuscitation plus 2024-12, Vol.20, p.100770, Article 100770
• Main Authors: Duignan, Kevin M., Luu, Hannah, Delgado, João H., London, Shawn, Ratzan, Richard M.
• Format: Article
• Language: English
• Subjects: Accidental death; Cardiac arrest; Cardiomyopathy; Drowning; Health disparities; Injury science; Review
• ISSN: 2666-5204; 2666-5204
• DOI: 10.1016/j.resplu.2024.100770

Drowning is a cause of significant morbidity and mortality worldwide. In most circumstances, the proximate cause is attributable to human factors, such as inexperience, fatigue, intoxication, or hazardous water conditions. The phenomenon of drowning incidents precipitated by unusualcircumstances (DIPUCs) – either fatal or nonfatal – involving otherwise healthy individuals under generally safe conditions has not been comprehensively addressed in the medical and drowning literature to date. In this review, we discuss etiologies of DIPUCs, diagnostic clues, suggested workup, suggested postmortem testing, and implications for surviving patients and families. Identifying the cause of a drowning incident can be extremely challenging forthe initially treatingphysician, relying perforce on historical context, environmental clues, physical exam, medical history, eyewitness accounts or video recordings. If no clear explanation for a drowning incident emerges despite a thorough investigation, clinicians should consider some of the less commondiagnoseswedescribe in this paper, and, when appropriate, refer for an autopsy with postmortem molecular genetic testing. While time-consuming, these efforts can provelife-savingfor some non-fatal drowning victims and the families of all victims of DIPUCs.