Presence of periorbital and conjunctival petechial hemorrhages in accidental pediatric drowning

Somers, Gino R.; Chiasson, David A.; Taylor, Glenn P.

doi:10.1016/j.forsciint.2007.07.007

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Volume 175, Issue 2 , Pages 198-201, 5 March 2008

Presence of periorbital and conjunctival petechial hemorrhages in accidental pediatric drowning

Gino R. Somers
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ont., Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont., Canada
- Corresponding author at: Department of Paediatric Laboratory Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8, Canada. Tel.: +1 416 813 5430; fax: +1 416 813 5974.
David A. Chiasson
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ont., Canada
- Paediatric Forensic Pathology Unit, Hospital for Sick Children, Toronto, Ont., Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont., Canada
Glenn P. Taylor
- Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ont., Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont., Canada

Received 27 December 2006; received in revised form 27 February 2007; accepted 3 July 2007. published online 24 August 2007.

Abstract

The pathological findings of drowning are variable and non-specific. Petechial hemorrhages involving the periorbital region and the conjunctiva have been described in many causes of death, but are thought to be exceedingly uncommon in cases of drowning. However, such studies have not specifically addressed the pediatric population. The current study retrospectively examined 79 cases of accidental pediatric drowning for the presence of periorbital/conjunctival hemorrhages and analyzed factors that may have affected their presence. Ten victims had periorbital/conjunctival petechial hemorrhages (13%), with five having periorbital petechiae, three having conjunctival petechiae, and two having both periorbital and conjunctival petechiae. The age and gender of the victim, site of drowning, resuscitation history and the presence of other pathological findings were not significantly associated with the presence of periorbital/conjunctival petechiae. However, as the interval between the drowning episode and autopsy increased, the incidence of periorbital/conjunctival petechiae decreased (28% for <24h; 7% for >24h). The presence of periorbital/conjunctival hemorrhages in a significant proportion of pediatric drowning victims confirms that the pathologist must add this finding to the spectrum of changes seen in pediatric drowning.