Advertisement

Pizza in adults and grape in children are the most frequent causes of foreign body airway obstruction in Italy. A national media-based survey

      To the Editor,
      Foreign-body airway obstruction is a relevant public health problem but data in medical literature are scarce and fatal events are dramatically under-reported.
      • Lorenzoni G.
      • Azzolina D.
      • Soriani N.
      • Galadini M.
      • Carle F.
      • Gregori D.
      Temporal and regional trends of choking injuries in children in Italy, 2001-2013.
      We searched mass media reported deaths over an 18 months period (January 1st 2018–July 1st 2019) to give a real estimation of this problem and to raise awareness about this topic and education in emergency maneuvers.
      We identified 64 deaths caused by the accidental inhalation of a foreign body or food in Italy, almost one case per week in a country with 60 million inhabitants. Interestingly, in our report choking events were not limited to prescholar children (28%) or elderly (>64 y) people (31%). Our findings confirmed that the causes of choking vary with age: children tend to explore their surroundings and were the only ones to suffocate with non-food obstruction (inappropriate objects, eg toys).
      In elderly people, particularly when a physical or neurologic impairment was present, foreign body airways obstruction occurred because of misdirecting of food into the airways rather than the gastrointestinal tract during the pharyngeal stage of deglutition.
      Review of inhaled foregin body.
      In our case series we confirmed that males, especially the pre-scholar children, are more susceptible to choking, probably due to their adventurous and impulsive personality.
      • Shlizerman L.
      • Ashkenazi D.
      • Mazzawi S.
      • Harefuah R.Y.
      Foreign body aspiration in children: ten-years experience at the Ha’Emek Medical Center.
      We analyzed the most dangerous food (Table 1): while pizza was the most dangerous food for adults, grape was the most dangerous one in children.
      Table 1Most frequent killer food.
      Total (n = 64)Children (n = 20)Adults (n = 24)Elderly (n = 20)
      1stPizza; n (%)6 (10%)02 (8%)4 (20%)
      2ndMeat; n (%)5 (8%)1 (5%)2 (8%)2 (10%)
      3rdGrapes; n (%)4 (6%)3 (15%)1 (5%)0
      4thPanettone cake; n (%)4 (6%)02 (8%)2 (10%)
      5thSandwich; n (%)3 (5%)02 (8%)1 (5%)
      Other kind of food
      Others: bread, fish, chicken bone, apple, bacon, boiled vegetables, pastry, pasta, candy, soup, cereals and pop corn.
      20 (31%)11 (55%)6 (25%)3 (15%)
      Unspecified food18 (28%)1 (5%)9 (38%)8 (40%)
      No food
      Parfum cap, stone, rubber ball and a little toy.
      ; n (%)
      4 (6%)4 (20%)00
      a Others: bread, fish, chicken bone, apple, bacon, boiled vegetables, pastry, pasta, candy, soup, cereals and pop corn.
      b Parfum cap, stone, rubber ball and a little toy.
      The majority of fatal choking were witnessed, but half of the witnessed cases died before first aid maneuvers, suggesting poor education in emergency maneuvers. Notably, the majority (80%) of elderly patients died before the arrival of the emergency team, while most (67%) of pre-scholar children died after hospital admission.
      Two cases (3% of patients) were managed with hospital tracheostomy while no tracheostomy was performed out-of-hospital (with one case of trial because not performing an out of hospital tracheostomy). Delay in advanced assistance, while the patient was already hospitalized, was rarely claimed by relatives (only one case).
      Because fatal foreign body airways obstruction in Italy is a common and underestimated event and bystanders seem to have poor training in life saving maneuvers, we think it useful to raise the awareness of physicians about unreported fatal and non-fatal events.

      Funding

      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Declarations of interest

      None.

      References

        • Lorenzoni G.
        • Azzolina D.
        • Soriani N.
        • Galadini M.
        • Carle F.
        • Gregori D.
        Temporal and regional trends of choking injuries in children in Italy, 2001-2013.
        Inj Epidemiol. 2018; 5: 30
      1. Review of inhaled foregin body.
        Elsevier Inc, Amsterdam2007 (Available from:)
        • Shlizerman L.
        • Ashkenazi D.
        • Mazzawi S.
        • Harefuah R.Y.
        Foreign body aspiration in children: ten-years experience at the Ha’Emek Medical Center.
        Harefuah. 2006; 145 (631): 569-571