ABSTRACT
AIM: To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge. METHODS: We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1,2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review. RESULTS: We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n=4[0.4%] versus n=92[42.4%], p<0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively. CONCLUSIONS: Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.
ABSTRACT
Aim: To validate a case definition for foreign body airway obstructions (FBAO) using International Classification of Diseases version 10 (ICD-10) codes to accurately identify patients in administrative health databases and improve reporting on this injury. Methods: We identified prehospital patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31, 2021 by querying the provincial emergency medical services' (EMS) patient care records for FBAO-related presentations, EMS protocols, or treatments. We deterministically linked EMS patient encounters to data on emergency department visits and hospital admissions, which included ICD-10 codes. Two physicians independently reviewed encounters to determine true FBAO cases. We then calculated diagnostic accuracy measures (sensitivity, specificity, likelihood ratios) of various algorithms. Results: We identified 3677 EMS patient encounters, 2121 were linked to hospital administrative databases. Of these encounters, 825 (38.9%) were true FBAO. The combination of two ICD-10 codes (T17 = foreign body in the respiratory tract or T18.0 = foreign body in the mouth) was the most specific algorithm (96.9% [95%CI 95.8-97.8%]), while the combination of all FBAO-related ICD-10 codes and R06.8 (other breathing abnormalities) was the most sensitive (75.0% [95%CI 71.9-78.0]). We identified an additional 453 (35.4%) FBAO cases not transported by EMS (due to death or transport refusal), and therefore not linked to the hospital administrative databases. Of these unlinked encounters, 44 (9.7%) cases resulted in the patient's death. Conclusions: FBAO can be identified with reasonable accuracy using health administrative data and ICD-10 codes. All algorithms had a trade-off between sensitivity and specificity, and failed to identify a third of FBAO cases, of which 10% resulted in death.
ABSTRACT
BACKGROUND: Patients presenting to the emergency department with a possible barbeque brush bristle ingestion pose many challenges. A detailed history and oral examination is needed and the typical first line investigation involves flexible laryngoscopy for direct visualization of the bristle. Given the high rate of false negatives with laryngoscopy, further imaging may be required in patients with a high suspicion of bristle ingestion Case Reports: We report on two cases presenting to the emergency department with pain following ingestion of grilled food. In both cases imaging was required to identify and assist with the removal of the bristle. Why Should an Emergency Physician Be Aware of This? Emergency physicians should have a high index of suspicion for bristle ingestion in patients with acute onset of pain or a foreign body sensation after ingesting grilled meats. Patients may require imaging to identify bristles if physical examination and laryngoscopy is negative.
