ASHA journals
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An integrative review of choking incidents (Hemsley et al., 2019)

journal contribution
posted on 2019-05-16, 23:26 authored by Bronwyn Hemsley, Joanne Steel, Justine Joan Sheppard, Georgia A. Malandraki, Lucy Bryant, Susan Balandin
Purpose: The purpose of this study was to conduct an integrative review of original research, across adult populations relating to fatal or nonfatal choking on food, to understand ways to respond to and prevent choking incidents.
Method: Four scientific databases (CINAHL, Medline, Web of Science, and EMBASE) were searched for original peer-reviewed research relating to fatal or nonfatal choking on foods. Data were extracted on study characteristics; factors leading up to, events at the time of, and actions taken after the choking incident; and impacts of choking incidents. An integrative review of the findings across studies identified several risk factors and recommendations to reduce the risk of choking.
Results: In total, 52 studies met the criteria for inclusion in this review, of which 31 were quantitative, 17 were qualitative, and 4 were of a mixed methods design. Studies reported the observations and narratives of bystanders or researchers, or else were large-scale autopsy studies, and included both the general public and people at risk of dysphagia. A range of food types were involved, and several actions were reported in response to food choking. Strategies to reduce the risk of choking were identified in the studies and are presented in 5 main categories.
Conclusions: Factors leading up to choking incidents extend well beyond the individual to the environment for mealtimes; the provision of appropriate mealtime assistance and oral care; and regular monitoring of general health, oral health, and medications. Bystanders’ increased awareness and knowledge of how to respond to choking are vital. The results of this review could be used to inform service policy and training, for individuals at risk of choking, the people who support them, and the general public. Further research is needed to explore choking prevention and airway protection in individuals with dysphagia.

Supplemental Material S1. Reason for paper exclusion from final analysis.

Supplemental Material S2. Characteristics of the choking event.

Hemsley, B., Steel, J., Sheppard, J. J., Malandraki, G. A., Bryant, L., & Balandin, S. (2019). Dying for a meal: An integrative review of characteristics of choking incidents and recommendations to prevent fatal and nonfatal choking across populations. American Journal of Speech-Language Pathology, 28, 1283–1297.


This research was supported by a grant from the National Health and Medical Research Council of Australia. Justine