{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:11:50Z","timestamp":1788779510100,"version":"build-2803163510"},"reference-count":16,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The forensic diagnosis of drowning lacks pathognomonic signs, and visceral weight-based indices normalised to spleen or heart weight have shown variable discriminant performance. We assessed a height-normalised revised Drowning Index (rDI) as a measure of thoracic fluid burden in confirmed drowning cases, not as a case\u2013control test of drowning versus non-drowning deaths. Methods: Fifty-five institutional drowning cases (Ancona and Turin Province, Italy, 2008\u20132020) were analysed. The rDI and the original spleen-normalised Drowning Index (DI) were calculated. A multivariable linear regression assessed sex, water type, and toxicological status as simultaneous covariates; a receiver operating characteristic (ROC) analysis evaluated the within-cohort classification of water type; and the associations with the postmortem interval (PMI) were explored separately. Results: The rDI was independently associated with the male sex (standardised \u03b2 = 0.391, p = 0.002) and saltwater drowning (\u03b2 = 0.331, p = 0.011; adjusted R2 = 0.269). The three benzodiazepine-positive institutional cases had a lower rDI in the univariate analysis (p = 0.019), but the association was not retained in the multivariable model or in a freshwater-restricted sensitivity analysis. Alcohol exposure showed no association. The water-type ROC analysis yielded an area under the curve of 0.727 (95% CI 0.553\u20130.871); the distributions overlapped substantially. The original DI was not associated with the variables studied. The rDI showed no significant association with the PMI within the range represented by all but one case (1\u201312 days). Conclusions: The rDI quantified the variation in the thoracic fluid burden within this cohort of confirmed drownings and showed moderate, exploratory water-type classification. It is not a stand-alone diagnostic test, and its discrimination ability between drowning and non-drowning deaths was not assessed. Dedicated case\u2013control and external validation studies are required before forensic cut-offs can be recommended.<\/jats:p>","DOI":"10.3390\/diagnostics16172870","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:23:37Z","timestamp":1788773017000},"page":"2870","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Height-Normalised Revised Drowning Index for Thoracic Fluid Burden: Associations with Water Type, Sex, Toxicology and Postmortem Interval"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0044-1714","authenticated-orcid":false,"given":"Eva","family":"Montanari","sequence":"first","affiliation":[{"name":"Department of Excellence Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5801-8444","authenticated-orcid":false,"given":"Cristian","family":"D\u2019Ovidio","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Department of Medicine and Aging Sciences, G. d\u2019Annunzio University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"D\u2019Anna","sequence":"additional","affiliation":[{"name":"Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy"},{"name":"Tumor Immunology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"},{"name":"Legal Medicine Unit, University Hospital \u201cPaolo Giaccone\u201d, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9673-4820","authenticated-orcid":false,"given":"Emina","family":"Dervi\u0161evi\u0107","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, 71 000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Rosa","sequence":"additional","affiliation":[{"name":"S.C. Medicina Legale, A.S.L. Citt\u00e0 di Torino, 10135 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariu Alexandru","family":"Apostol","sequence":"additional","affiliation":[{"name":"Medicina Legale, A.S.L. TO4, Ivrea, 10015 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8501-4799","authenticated-orcid":false,"given":"Alberto","family":"Salomone","sequence":"additional","affiliation":[{"name":"Dipartimento di Chimica, Universit\u00e0 degli Studi di Torino, 10125 Turin, Italy"},{"name":"Centro Regionale Antidoping e di Tossicologia \u201cA. Bertinaria\u201d, Orbassano, 10043 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Gerace","sequence":"additional","affiliation":[{"name":"Centro Regionale Antidoping e di Tossicologia \u201cA. Bertinaria\u201d, Orbassano, 10043 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail Ozgur","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, School of Medicine, Dokuz Eylul University, 35340 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2607-2734","authenticated-orcid":false,"given":"Roberto","family":"Campagna","sequence":"additional","affiliation":[{"name":"Department for the Promotion of Human Science and Quality of Life, San Raffaele Roma University, Via di Val Cannuta, 247, 00166 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-6523","authenticated-orcid":false,"given":"Angelo","family":"Montana","sequence":"additional","affiliation":[{"name":"Department of Excellence Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.forsciint.2004.10.027","article-title":"Drowning: Still a difficult autopsy diagnosis","volume":"163","author":"Piette","year":"2006","journal-title":"Forensic Sci. 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