Suffocation Injuries in the United States: Patient Characteristics and Factors Associated with Mortality

FOREIGN BODY ASPIRATION AND INGESTION IN CHILDREN

Aspiration and ingestion of a foreign body is most frequently seen in children younger than 3 years. Foreign body aspiration is always a life-threatening, urgent state demanding quick recognition and treatment to avoid potentially lethal complications. Most foreign bodies that are ingested pass spontaneously through the gastrointestinal tract without complications, however, some could lead to problems if they become lodged. A literature review was performed via MEDLINE database using key terms. Primary care providers should be trained to give proper initial care. Aspirated/ingested foreign bodies in children removed by rigid or flexible bronchoscopy/gastroscopy always are challenging procedures that require well-planned anesthesia management and excellent intercommunication between anesthesiologists and surgeons. Extracorporeal membrane oxygenation can be used as a rescue mode of support in children with life-threatening foreign body aspiration for stabilization before, during and after removal of the aspirated foreign body. It is of utmost importance that all foreign body extractions, if possible, be done in centers supplied with all the necessary equipment and trained personnel. However, prevention of foreign body aspiration and ingestion is still the best therapy.

Choking injuries: Associated factors and error-producing conditions among acute hospital patients in Japan

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.

Unexpected death of an infant suffocated in the course of breastfeeding when the mother fell asleep

Death following accidental suffocation due to overlaying is often overlooked, and still attributed to Sudden Infant Death Syndrome (SIDS). We report a case of sudden infant death following accidental suffocation due to breast overlaying during breastfeeding. We report the death of a two-month-old male baby, without medical history, who was found lifeless wedged under his mother's breast. The mother subsequently admitted that she had fallen asleep while breastfeeding and awoke a few minutes later to find him wedged under her breast and not breathing. External examination of the infant's body revealed right frontal congestion with reddish-purple colour of the right frontal skin corresponding to where the mother's breast had overlaid his face with bilateral conjunctival petechiae with no signs of external injury. Internal examination revealed congestion with petechiae marks of the internal side of the right frontal scalp, with moderate congestion and few petechiae marks at the level of the lungs. The histopathological examination showed non-specific passive congestion, with no abnormalities. The cause of death was attributed to accidental suffocation following obstruction of external airways by the mother's breast during breastfeeding. Accidental asphyxia cases require extensive investigation of the circumstances surrounding death, reconstruction of events, and careful documentation of the findings observed at autopsy with full histological examination which may become relevant in a specific case in later stages of the investigation.

Learning from suicide deaths in Harris County, Texas

This study examined individual and community demographic characteristics surrounding suicides in one of the most populous counties in the United States. We paired medical examiner records with U.S. Census data and analyzed them using geospatial software. The majority of decedents were non-Hispanic, white males who died primarily of gunshot wounds. Salient age characteristics included interpersonal violence and depression among ages younger than 40. Despite lower incomes and education levels, areas with higher population density and racial/ethnic minorities had fewer suicides. Additional research should address depression among males and the elderly, interpersonal violence, firearm access, and culture.

Assault by strangulation: sex differences in patient profile and subsequent readmissions

OBJECTIVES

Assault by strangulation has the potential for severe brain injury or death. The objectives of this study were to describe the profile of individuals who had strangulation-related emergency department (ED) or acute care visits, and to explore 1-year readmission outcomes among survivors.

METHODS

A population-based retrospective cohort study was conducted using health administrative data in Ontario, Canada. Adults aged 15 years and older who were seen in the ED or acute care with assault by strangulation between fiscal years 2002/2003 and 2016/2017 were included in the study. Bivariate analyses were conducted to compare the patient profile and subsequent readmissions within 1 year of discharge, stratified by sex.

RESULTS

A total of 586 patients were included in the study. The majority of these patients were seen in the ED (93%), predominantly female (70%), aged ≤ 39 years (68%), and of lower income quintiles of ≤ 3 (73%). Of the 579 patients who survived the initial admission, 52% had subsequent ED readmission and 21% had acute care readmission within 1 year. In sex-stratified analyses, a higher proportion of females were between 20 to 39 years (58.7% vs. 44.1%, p = 0.001), discharged home (88% vs. 81%, p < 0.001), and had ED readmission within 1 year of discharge (56% vs. 17%, p = 0.002). Males had comparatively higher 1-year acute care readmissions.

CONCLUSION

The study shows high readmissions with sex differences among individuals with an assault by strangulation, suggesting sex-specific approach to health care practices to support the needs of this vulnerable population, thus reducing health system inefficiencies.

Cases of asphyxia in children and adolescents: a retrospective analysis of fatal accidents, suicides, and homicides from 1998 to 2017 in Hamburg, Germany

PURPOSE

Injury-related asphyxia is one of the most common causes of death in children in Germany. However, only a few systematic studies have analyzed the causes and circumstances of asphyxia in children and adolescents.

METHODS

All cases of asphyxia in children and adolescents (0-21 years of age) among the Hamburg Legal Medical Department's autopsy cases from 1998 to 2017 were retrospectively analyzed with special focus on how often external findings were completely absent.

RESULTS

Among 249 cases of fatal asphyxia, 68% were accidents, 14% were suicides, and 13% were homicides. Most of the cases involved boys. Adolescents and young adults aged 15-21 years represented the main age group. Drowning was the leading mechanism of asphyxia. Younger age was associated with less frequent detection of external signs of asphyxia in the postmortem external examination. Petechial hemorrhages were the most common visible external indication of asphyxia. No external findings indicative of asphyxia were present in 14% of the cases.

CONCLUSION

Asphyxia in children and adolescents often involves accidents. However, postmortem external examination alone is insufficient to identify asphyxia and the manner of death.

Evaluation of Nonfatal Strangulation in Alert Adults

STUDY OBJECTIVE

There is a paucity of evidence to guide the diagnostic evaluation of emergency department (ED) patients presenting after nonfatal strangulation (manual strangulation or near hanging). We seek to define the rate of serious injuries in alert strangled patients and determine which symptoms and examination findings, if any, predict such injuries.

METHODS

Using prospectively populated databases and electronic medical record review, we performed a retrospective analysis of alert strangled patients treated in the ED of an academic Level I trauma center. Exclusions were Glasgow Coma Scale (GCS) score less than 13, younger than 16 years, and interhospital transfers. Trained researchers used structured forms to abstract demographics, symptoms, examination findings, radiology and operative findings, and final diagnoses. Injuries requiring greater than 24 hours' observation or specific treatment (surgery, procedure, specific medication) were considered clinically important. The electronic medical record was searched for 30 days after presentation to identify missed injuries.

RESULTS

Advanced imaging (computed tomography or magnetic resonance maging) was obtained in 60%. Injuries were identified in 6 patients (1.7%, 95% CI, 0.7% to 3.6%). Two injuries were clinically important (0.6%, 95% CI, 0.1% to 2.0%). Both were cervical artery dissections with no neurologic deficits, treated with aspirin. No additional injuries were identified within 30 days or at next medical contact. Of 343 uninjured patients, 291 (85%) had documented medical follow up confirming the absence of any new diagnosis of injury or stroke. The small number of injuries precluded analyses of associations.

CONCLUSION

Alert, strangled patients had a low rate of injuries. All patients with neck injuries had concerning findings besides neck pain; specifically, GCS score less than 15 or dysphagia. Our findings suggest, but do not prove, that a selective imaging strategy is safe in alert patients after strangulation findings besides neck pain.