The Drowning Index (DI) can help to distinguish death by drowning from other causes.


(1) weight of left and right lungs in grams

(2) weight of pleural fluid in grams

(3) weight of spleen in grams


drowning index =

= ((weight of lungs) + (weight of pleural fluid)) / (weight of spleen)



• The higher the index the greater the risk that death occurred due to drowning.

• Sugimura et al used a DI >= 14.1 for patients recovered within 2 weeks of death.

• In Figure 1 the weight of the pleural effusion was significantly greater than for asphyxia or cardiac death, with > 100 grams seen in drowning. Lung weight alone showed considerable overlap between the different causes of death.



• The presence of splenomegaly would lower the ratio. The spleen weight tended to be higher in patients with a cardiac death.



• Sugimura et al reported a sensitivity of 66% and specificity of 78%.

• Wardak et al found that the DI was neither sensitive (< 10%) for drowning nor specific (60-70%).

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