Original communicationCafé coronary syndrome-fatal choking on food: An autopsy approach
Introduction
‘Café coronary’ was the term coined by Haugen in 1963 for sudden and unexpected death occurring during a meal due to accidental occlusion of the airway by food.1 The typical victim of a café coronary was initially thought to be a previously healthy middle-aged male with predisposing factors including a large food bolus, poor condition or absence of the teeth, and alcohol intoxication, with a comment that ‘prevention depends upon table manners’.1 Further studies, however, showed that the range of victims was broader than this and included individuals with neurological conditions such as atherosclerotic cerebrovascular disease, dementia and Parkinson’s disease, and those on sedative or antipsychotic medication. It may also occur in young children.2, 3, 4
To further examine the types of conditions associated with fatal food asphyxia and the circumstances surrounding these deaths a series of cases from Forensic Science SA was examined. An autopsy approach to such cases has been formulated.
Section snippets
Materials and methods
A retrospective study was undertaken of the autopsy files at Forensic Science SA (FSSA) in Adelaide, South Australia, for all cases of café coronary, or choking on food, over a 10-year-period from January 1993 to December 2002. FSSA provides autopsy services to the State Coroner for the state of South Australia, Australia, which currently has a population of approximately 1.5 million people. Over 95% of the state’s coronial autopsies are performed at the Centre.
All cases were the subject of
Results
Forty-four cases were identified over the ten-year period of the study. Twenty-one of the victims (48%) were male and twenty-tree were female (52%). There was only one paediatric case involving an 11-month-old male infant who choked on a grape. The age range of the adults was 30 to 96 years (mean 68.9 yrs), with a preponderance of victims (57%) aged between 71 and 90 years (Fig. 1).
In 37 cases the location of the choking episode was noted. In twenty-two of the 37 cases with information (59.5%),
Discussion
The incidence of food asphyxia, café coronary or ‘bolus death’5, 6 varies among populations and at different ages from 0.1 to 2 cases per 100,0003, 7. As was demonstrated in the current study the most at-risk individuals are not healthy middle-aged males, but elderly, physically or mentally impaired individuals; i.e., 57% of our cases were aged between 71 and 90 years, with an average age in the adults of 68.9 years. Other studies have also shown that victims to be in their seventh decade,2 or
Acknowledgement
We thank the South Australian State Coroner, Mr. Wayne Chivell, for permission to publish details of these cases.
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