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Saccomanno S, Saran S, Coceani Paskay L, De Luca M, Tricerri A, Mafucci Orlandini S, Greco F, Messina G. Risk factors and prevention of choking. Eur J Transl Myol 2023; 33:11471. [PMID: 37905785 PMCID: PMC10811631 DOI: 10.4081/ejtm.2023.11471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances). The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%) and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.
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Affiliation(s)
- Sabina Saccomanno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila.
| | - Stefano Saran
- Department of Human Sciences, Innovation and Territory, School of Dentistry, University of Insubria, Varese.
| | | | - Martina De Luca
- Dental School, Catholic University of the Sacred Heart, Italy Rome.
| | | | | | - Francesca Greco
- Department of Radiology, New San Giovanni Battista Hospital, Foligno.
| | - Giuseppe Messina
- Department of Human Sciences and Promotion of the Quality of life of San Raffaele University Rome.
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2
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Birkun A. Toward development of the standardized dispatcher algorithm for telephone assistance in choking. Acad Emerg Med 2022; 29:1401-1402. [PMID: 35881011 DOI: 10.1111/acem.14572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Alexei Birkun
- Department of General Surgery, Anaesthesiology, Resuscitation and Emergency Medicine, Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol, Russian Federation
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3
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Choking injuries: Associated factors and error-producing conditions among acute hospital patients in Japan. PLoS One 2022; 17:e0267430. [PMID: 35476697 PMCID: PMC9045662 DOI: 10.1371/journal.pone.0267430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
Abstract
Choking can lead to mortality and residual impairments. This study aimed to determine the factors associated with choking among acute hospital patients and examine error-producing conditions to suggest choking-prevention policies. Among 36,364 cases reported by hospital staff at an acute university hospital from 2012 to 2018 were examined using a retrospective study, 35,440 were analysis as the number of cases analysed for the study. We used descriptive statistics to present patient characteristics and conducted univariable and multivariable logistic regression analyses to identify factors associated with choking. Additionally, we conducted content analysis (root cause analysis) to examine error-producing conditions and prevention policies. Sixty-eight cases were related to choking injuries; of these, 43 patients (63.2%) were male, and 38 (55.9%) were aged 65 years and older. Choking cases had a high percent of adverse outcomes involving residual impairment or death (n = 23, 33.8%). Mental illness (adjusted odds ratio [95% confidence interval]: 3.14 [1.39−7.08]), and hospitalisation in the general wards (adjusted odds ratio [95% confidence interval]: 3.13 [1.70−5.76]) were associated with an increased probability of choking. Error production was caused by food (n = 25, 36.8%) and medical devices or supplies (n = 13, 19.1%). Almost all contributory factors were associated with inadequate checking (n = 66, 97.1%) and misperception of risk (n = 65, 95.6%). Choking poses a highly significant burden on patients, and hospital administrators should minimise the risk of choking to prevent related injuries. Hospital administrators should provide training and education to their staff and develop adequate protocols and procedures to prevent choking.
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4
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Katabami K, Kimura T, Hirata T, Tamakoshi A. Risk Factors of Mortality from Foreign Bodies in the Respiratory Tract: The Japan Collaborative Cohort Study. Intern Med 2022; 61:1353-1359. [PMID: 35491176 PMCID: PMC9152875 DOI: 10.2169/internalmedicine.8437-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. Results Among all participants, 202 deaths occurred from foreign bodies in the respiratory tract. In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.
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Affiliation(s)
- Kenichi Katabami
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Takashi Kimura
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Japan
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5
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Hamasaki T, Hagihara A. Medical malpractice litigation related to choking accidents in older people in Japan. Gerodontology 2020; 38:104-112. [PMID: 33169853 DOI: 10.1111/ger.12506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse malpractice litigation cases in Japan and identify the factors related to choking accidents in older people. BACKGROUND Choking while eating is common in older people and has potentially severe consequences. METHODS This study analysed court decisions related to choking accidents occurring in Japan between 2000 and 2015 that involved the death of an older person or permanent severe choking-related injury. A database of court decisions (n = 23) was constructed according to patient and caregiver characteristics, and nursing services. An analysis was performed on caregiver liability, and to identify factors related to choking accidents. RESULTS The court ruled that the caregiver was liable in 10 of the 23 cases. Liability was related to appropriate food choices, failure to monitor of eating or the non-performance of resuscitation after an accident. Prior knowledge of aspiration (P < .001), inappropriate assistance during the meal (P < .001), and inappropriate emergency treatment (P = .028) were more likely to be present in cases in which caregivers were judged liable than in those in which they were not. CONCLUSIONS Lack of appropriate assistance during the meal was the factor most strongly associated with a court ruling of caregiver liability for choking accidents in older people.
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Affiliation(s)
- Tomoko Hamasaki
- Department of Nutrition Faculty of Home Economics, Kyushu Women's University, Kitakyushu, Japan
| | - Akihito Hagihara
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
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6
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Taniguchi Y, Iwagami M, Sakata N, Watanabe T, Abe K, Tamiya N. Epidemiology of Food Choking Deaths in Japan: Time Trends and Regional Variations. J Epidemiol 2020; 31:356-360. [PMID: 32536639 PMCID: PMC8021878 DOI: 10.2188/jea.je20200057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background With increasing age globally, more people may become vulnerable to food choking. We investigated the nationwide epidemiology of food choking deaths in Japan. Methods Using Japanese Vital Statistics death data between 2006 and 2016, we identified food choking deaths based on the 10th revision of the International Statistical Classification of Diseases code W79 (Inhalation and ingestion of food causing obstruction of respiratory tract) as a primary diagnosis. We assessed the demographics of people with food choking deaths; temporal trends of food choking deaths by the year (overall and by age group), the day of year; and prefecture variations. Results Overall, 52,366 people experienced food choking deaths (median age, 82 years, 53% were male, and 57% occurred at home). The highest numbers occurred January 1–3, and were lowest in June. Despite a stable total number of cases at around 4,000 yearly, from 2006 to 2016 the incidence proportion declined from 16.2 to 12.1 per 100,000 population among people aged 75–84 years. Among people ≥85 years, the incidence proportion peaked at 53.5 in 2008 and decreased to 43.6 in 2016. The number of food choking deaths varied by prefecture. Conclusions There are temporal and regional variations of food choking deaths in Japan, possibly due to the consumption of Japanese rice cake (mochi), particularly over the New Year’s holiday.
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Affiliation(s)
- Yuta Taniguchi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
| | - Kazuhiro Abe
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba.,Health Services Research and Development Center, University of Tsukuba
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Hemsley B, Steel J, Sheppard JJ, Malandraki GA, Bryant L, Balandin S. Dying for a Meal: An Integrative Review of Characteristics of Choking Incidents and Recommendations to Prevent Fatal and Nonfatal Choking Across Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1283-1297. [PMID: 31095917 DOI: 10.1044/2018_ajslp-18-0150] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents. Method Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peer-reviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking. Results In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories. Conclusions Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders' increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia. Supplemental Material https://doi.org/10.23641/asha.8121131.
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Affiliation(s)
- Bronwyn Hemsley
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Joanne Steel
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
- The University of Newcastle, NSW, Australia
| | - Justine Joan Sheppard
- Department of Biobehavioral Sciences, Teacher's College, Columbia University, New York, NY
| | - Georgia A Malandraki
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN
| | - Lucy Bryant
- Graduate School of Health, The University of Technology, NSW, Sydney, Australia
| | - Susan Balandin
- School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
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8
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Balica NC, Sitaru AM, Boia ER, Horhat DI, Mot IC, Chioreanu A, Poenaru M. Laryngotracheal foreign body: chicken neck bone. J Int Med Res 2019; 47:2764-2767. [PMID: 31109227 PMCID: PMC6567700 DOI: 10.1177/0300060519848260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We herein present a case involving a 78-year-old patient who had aspirated a laryngotracheal foreign body 3 days prior to hospital admission. The patient had severe congenital intellectual disability; however, no agitation, suffocation, or death occurred despite almost complete laryngeal obstruction. The laryngotracheal foreign body was removed by tracheotomy and suspended microlaryngoscopy.
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Affiliation(s)
| | | | - Eugen Radu Boia
- ENT Department, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Ion Cristian Mot
- ENT Department, University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Marioara Poenaru
- ENT Department, University of Medicine and Pharmacy, Timisoara, Romania
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9
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Luczak A. Effect of body position on relieve of foreign body from the airway. AIMS Public Health 2019; 6:154-159. [PMID: 31297401 PMCID: PMC6606524 DOI: 10.3934/publichealth.2019.2.154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022] Open
Abstract
Foreign body airway obstruction (FBAO), or commonly known as choking, is an extremely dangerous event. The European Resuscitation Council recommends that back blows and abdominal thrusts should be performed for relieving FBAO in conscious adults. Reviewed here evidence suggests that applying a prone or a head-down position increases effectiveness of the above standard approaches to relieve obstruction, due to help of gravity.
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Affiliation(s)
- Artur Luczak
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
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10
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Chen R, Chien WC, Kao CC, Chung CH, Liu D, Chiu HL, Chou KR. Analysis of the risk and risk factors for injury in people with and without dementia: a 14-year, retrospective, matched cohort study. Alzheimers Res Ther 2018; 10:111. [PMID: 30376887 PMCID: PMC6208020 DOI: 10.1186/s13195-018-0437-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan. METHODS We collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries. RESULTS The 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer's disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65-74 years, and seeking medical attention for an injury within the past year. CONCLUSION People with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.
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Affiliation(s)
- Ruey Chen
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, No.325, Section 2, Cheng-Kung Road, Neihu District, Taipei, 11490 Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
| | - Ching-Chiu Kao
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, No.161, Section 6, Min-Chuan East Road, Neihu District, Taipei, 11490 Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Taipei, 11696 Taiwan
| | - Huei-Ling Chiu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
| | - Kuei-Ru Chou
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, Taipei, 23561 Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, No.250, Wu-Hsing Street, Taipei, 11031 Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, No.252, Wuxing St, Xinyi District, Taipei, 110 Taiwan
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11
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Pavitt MJ, Nevett J, Swanton LL, Hind MD, Polkey MI, Green M, Hopkinson NS. London ambulance source data on choking incidence for the calendar year 2016: an observational study. BMJ Open Respir Res 2017; 4:e000215. [PMID: 29299326 PMCID: PMC5728301 DOI: 10.1136/bmjresp-2017-000215] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 11/03/2022] Open
Abstract
Introduction Complete foreign body airway obstruction is a life-threatening emergency, but there are limited data on its epidemiology. Methods We conducted a retrospective analysis of data collected routinely from London Ambulance Service calls coded as being for choking was undertaken for the calendar year of 2016. Results There were 1916 choking episodes of significant severity to call for emergency assessment in London during 2016, 0.2% of total calls requiring an ambulance response, an average of 5.2 per day. The incidence increased at the extremes of age. Calls coded as choking occurred at times consistent with lunch and dinner and less frequently at breakfast. Peak incidence occurred at Sunday lunchtimes and on Wednesday evenings. Conclusions Choking is a substantial health problem for Londoners to seek emergency assistance. Choking is more frequent at the extremes of age with a higher incidence at lunch and dinner time. Greater public awareness of choking and its management could help to prevent avoidable deaths.
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Affiliation(s)
- Matthew J Pavitt
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Harefield NHS Foundation Trust and Imperial College, London, UK
| | | | - Laura L Swanton
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Matthew D Hind
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Malcolm Green
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Harefield NHS Foundation Trust and Imperial College, London, UK
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12
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Wu WS, Sung KC, Cheng TJ, Lu TH. Associations between chronic diseases and choking deaths among older adults in the USA: a cross-sectional study using multiple cause mortality data from 2009 to 2013. BMJ Open 2015; 5:e009464. [PMID: 26563213 PMCID: PMC4654350 DOI: 10.1136/bmjopen-2015-009464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To examine whether the strengths of the associations between chronic diseases and overall choking differ from those of the associations between chronic diseases and only food-related choking. DESIGN This cross-sectional study used nationwide multiple cause mortality files. SETTING The USA. PARTICIPANTS Older adults aged 65 years or more died between 2009 and 2013. MAIN OUTCOME MEASURES Mortality ratio (observed/expected) of number of deaths from both causes (chronic diseases and choking) and 95% CIs. RESULTS We identified 76543 deaths for which the death certificates report choking (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes W78, W79 and W80 combined) as a cause of death and only 4974 (6.5%) deaths were classified as food-related choking (ICD-10 code W79). Schizophrenia, Parkinson's disease, Alzheimer's disease and oral cancer are four chronic diseases that had significant associations with both overall and food-related choking. Stroke, larynx cancer and mood (affective) disorders had significant associations with overall choking, but not with food-related choking. CONCLUSIONS We suggest using overall choking instead of only food-related choking to better describe the associations between chronic diseases and choking.
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Affiliation(s)
- Wen-Shiann Wu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kuan-Chin Sung
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Tain-Junn Cheng
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
- Department of Neurology, Occupational Medicine, Management in Medical Records and Information, Chi Mei Medical Center, Tainan, Taiwan
- Department of Occupational Safety/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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13
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Ibrahim JE, Murphy BJ, Bugeja L, Ranson D. Nature and extent of external-cause deaths of nursing home residents in Victoria, Australia. J Am Geriatr Soc 2015; 63:954-62. [PMID: 25940003 DOI: 10.1111/jgs.13377] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe the nature and extent of external-cause deaths of residents of nursing homes in Victoria, Australia. DESIGN A retrospective cohort study of all decedents using routinely collected data contained within the National Coronial Information System. SETTING Accredited nursing homes in Victoria. PARTICIPANTS Nursing home residents who had died from external causes and whose deaths were reported to the Coroners Court between July 1, 2000, and December 31, 2012. MEASUREMENTS Basic descriptive analysis was conducted to measure frequencies and proportion of exposures within each outcome group, and rates were calculated using population data. RESULTS One thousand two hundred ninety-six external cause deaths of nursing home residents were identified. Deaths were due to falls (n=1,155, 89.1%), choking (n=89, 6.9%), suicide (n=17, 1.3%), complications of clinical care (n=8, 0.6%) and resident-on-resident assault (n=7, 0.5%). Deaths occurred more frequently in women (n=814, 62.8%), in keeping with the sex distribution in nursing homes, and residents aged 85 and older (n=923, 71.2%). The number of inquests held to investigate a death as a matter of public interest was small (n=24, 1.9%). CONCLUSION A significant proportion of nursing home resident deaths are from external causes and are potentially preventable. A shift in community attitudes is required toward an understanding that premature death of a resident from injury is not a natural part of life.
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Affiliation(s)
- Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony J Murphy
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Ranson
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
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Kennedy B, Ibrahim JE, Bugeja L, Ranson D. Causes of death determined in medicolegal investigations in residents of nursing homes: a systematic review. J Am Geriatr Soc 2014; 62:1513-26. [PMID: 25040024 DOI: 10.1111/jgs.12929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To systematically review published research characterizing the nature and circumstances surrounding the death of older people in nursing homes specifically using information generated for medicolegal death investigations. DESIGN Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement using the key words death, nursing homes, and medicolegal death investigation. SETTING Cross-sectional data from original, peer-reviewed articles published in English between 2000 and 2013 describing deaths of nursing home residents. MEASUREMENTS Information was extracted for analysis about study and population characteristics, number and type of deaths, study design, findings, and limitations. RESULTS Thirteen studies were identified. The studies examined external causes of deaths from suicide, choking, restraint or bed-related injuries, falls, and pressure injuries. Deaths were more frequent in women with existing comorbidities. Suicide was predominant in men. Identified risk factors and opportunities to reduce harm were identified at individual, organizational, and structural levels. Overall, the quality of the studies limited the aggregation and comparability of findings. CONCLUSION This systematic review informs researchers, clinicians and policy-makers about how to reduce external causes of death in nursing homes.
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Affiliation(s)
- Briohny Kennedy
- Department of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
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Coffey A, Pasquale-Styles MA, Gill JR. Fatalities Due to Choking: Internal Occlusion of Airway. Acad Forensic Pathol 2014. [DOI: 10.23907/2014.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Deaths due to internal obstructions of the airway (choking) are preventable injuries that are often associated with underlying risk factors including neurologic impairment by disease, intoxication, or very young or old age. We reviewed 138 decedents with accidental internal obstruction of the airway. Records including autopsy, toxicology, and investigators’ reports were reviewed for a five-year period. There were 138 choking deaths and the age ranged from one to 96 years (mean = 57). Neurologic disease (e.g., remote cerebral vascular events, dementia, developmental disorders) was the most common risk factor for fatal choking (51%), followed by acute alcohol intoxication (13%), psychiatric illness (8%), and young age (8%). In 8% of decedents, there was no identifiable risk factor following investigation, autopsy, and toxicological examinations. The choking episode most commonly occurred in residences (62%), followed by nursing home/long-term care facilities (20%), streets/parks (6%), restaurants/bars (4%), and schools (1%, including one culinary school). Meat was the most commonly identified food object (14%); non-food objects included drug packets. It is exceedingly rare for a neurologically intact adult to choke to death on a bolus of food without another underlying, identifiable risk factor. For death investigation, it is important to have a high index of suspicion for choking, and one must be careful not to confuse terminal aspiration of gastric contents with a fatal blockage of the airway by a swallowed bolus of food. A risk factor should be sought in each choking death, as it usually is the underlying cause of death.
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Affiliation(s)
- Amy Coffey
- Columbia University Medical Center - Pathology and Cell Biology, New York, NY
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Chung CH, Lai CH, Chien WC, Lin CH, Cheng CH. A population-based study of inpatients admitted due to suffocation in Taiwan during 2005-2007. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:523-529. [PMID: 22717228 DOI: 10.1016/j.aap.2012.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 05/23/2012] [Accepted: 05/28/2012] [Indexed: 06/01/2023]
Abstract
The objective of this study was to analyze the epidemiology and factors associated with prognoses (inpatient fatality) of patients hospitalized due to suffocation. Data from 2005 to 2007 were sourced from the Taiwanese National Health Insurance Research Database. Suffocation was defined as E911-E915 according to the ICD-9-CM classification. In total, 4062 hospitalizations occurred in Taiwan due to suffocation from 2005 to 2007, with an inpatient fatality rate of 6.5%. Among hospitalizations due to suffocation, "foreign body unintentionally entering other orifice", "food causing obstruction", and "other object causing obstruction" accounted for 58.4%, 17.9%, and 11.0%, respectively. There were more cases of male inpatients than female patients; in terms of age, infants under 1 year old and the elderly aged 65 and over had the highest rates of hospitalization. Factors associated with inpatient fatality included "age", "cardiac arrest", "received surgery or procedure", "acute respiratory failure", "anoxic brain damage", and "foreign body in larynx". Infants and the elderly were high-risk groups for hospitalization as a result of suffocation; the dominant cause among inpatient fatality was "food causing obstruction", which accounted for 22.2% of cases. Medical institutions should focus on the factors associated with inpatient fatality to improve prognoses and decrease the fatality rates of inpatients.
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Affiliation(s)
- Chi-Hsiang Chung
- Graduate Institute of Life Sciences, National Defense Medical Center, Taiwan, Republic of China.
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Abstract
Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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Nikolić S, Živković V, Dragan B, Juković F. Laryngeal Choking on Food and Acute Ethanol Intoxication in Adults-An Autopsy Study*. J Forensic Sci 2011; 56:128-31. [DOI: 10.1111/j.1556-4029.2010.01510.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, Lerner EB, Rea TD, Sayre MR, Swor RA. Part 5: Adult Basic Life Support. Circulation 2010; 122:S685-705. [PMID: 20956221 DOI: 10.1161/circulationaha.110.970939] [Citation(s) in RCA: 480] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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