Suffocation Injuries in the United States

Patient Characteristics and Factors Associated With Mortality

Roula Sasso, MD; Rana Bachir, MPH; Mazen El Sayed, MD, MPH


Western J Emerg Med. 2018;19(4):707-714. 

In This Article


This study has limitations inherent to its retrospective nature. NEDS is, however, a large U.S. national database of ED visits and the study results can be generalized to other patients presenting with suffocation injuries in the U.S. or in other developed settings. The data was obtained from the NEDS database using ICD-9-CM codes for suffocation diagnosis. There could be an underestimation of the actual suffocation injury rates due to variations in coding in the 947 hospitals included in the database. It is also possible that many patients who died as a result of suffocation might not have been transported to the ED and therefore were not included in this study, which could potentially have led to underestimation of mortality rate of asphyxiation. The NEDS database is de-identified, so we could not identify patients with suffocation injury readmissions. Considering that a high percentage of patients had mental disorders or a history of injury and poisoning, it is likely that the number of readmissions in our selected population is significant. Other studies excluding readmissions might identify other factors associated with mortality in patients with suffocation injury. Patients presenting with a recurrent suffocation injury are also more likely to have poorer prognosis than those presenting with a suffocation injury for the first time.

This study included patients with suffocation from different mechanisms. Even though mortality rates were reported for different mechanisms when possible, restrictions related to availability of clinical variables limited our ability to draw more specific recommendations about clinical management or to identify whether the associated clinical conditions were comorbid conditions or arose as a result of the asphyxiation.