Fatalities Due to Choking: Internal Occlusion of Airway

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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.