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Factors influencing water-related fatalities are extending from intoxication through alcohol, pharmaceuticals and narcotic drugs to person-related medical conditions and the geography of the drowning environment. Consequently, cases suspected of drowning present a high variability in age, sex, seasonality, type of drowning, recovery site and state of body preservation by the time of recovery. All these factors affect the manifestation of drowning signs, which are investigated to enable a valid diagnosis of drowning. These drowning signs all result from physiological changes during the drowning process but are often non-specific in that they vary in abundance and severity of manifestation, also being prone to subsequent change by resuscitation efforts and decomposition processes, leaving the diagnosis of drowning as one of the most difficult tasks in forensic practice. By re-evaluating geographic, demographic, person-related and body condition data as well as diagnostic results of 158 water-related fatalities in Upper Austria and Salzburg from 2015 to 2022, this retrospective study reappraises the predictive strength of the drowning signs currently used in forensic practice, together with the influences acting on their formation and persistence. While some results are consistent with and affirm those of other studies with similar approaches, new relations were found regarding the differences in incidence rates between accident locations and water body types. Moreover, the main results identify that some drowning signs are of clearly higher predictive significance than others, and that predictive power increases with the number of signs coincidentally present but decreases with advancing decomposition. These findings underline the importance of a timely body recovery and in cases where not feasible, the need for additional alternative diagnostic measures.<\/jats:p>","DOI":"10.1007\/s00414-025-03675-z","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T01:02:17Z","timestamp":1765587737000},"page":"825-836","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Water-related fatalities in Salzburg and Upper Austria between 2015 and 2022 \u2013 a retrospective evaluation with a focus on the informative value of drowning signs"],"prefix":"10.1007","volume":"140","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9066-8499","authenticated-orcid":false,"given":"Dominik","family":"Hagen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio C.","family":"Monticelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Stoiber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Steinbacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Pittner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"3675_CR1","unstructured":"World Health Organization. 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