Pediatrics
“Suffocation roulette”: A case of recurrent syncope in an adolescent boy*

https://doi.org/10.1067/mem.2003.49Get rights and content

Abstract

We present the case of a 12-year-old boy admitted with a complaint of recurrent syncopal episodes. A careful history taking revealed the cause of the syncopal episodes to be a dangerous game played by adolescents called “suffocation roulette.” We believe that recognition of this game as a possible cause of syncopal events, together with prompt educative intervention, might prevent adolescent morbidity and mortality and also might eliminate the need for unnecessary medical investigations. [Ann Emerg Med. 2003;41:223–226.]

Introduction

Adolescents have acute and chronic medical problems, but the main sources of disease, death, and disability in this population result from risky behaviors and risky environments. The leading cause of death for adolescents and young adults (age 10 to 24 years) in both the United States and Canada is unintentional or intentional injury, which includes motor vehicle crashes or other unintentional injuries, homicides, and suicides. Together, these 4 causes account for almost 75% of deaths in this age group and for more than 80% of deaths of those aged 15 to 19 years.1

A variety of biological, psychological, social, and cultural factors contribute to the likelihood of involvement in risky behaviors. Health-risk behaviors and risky environmental factors occur together among adolescents.2 Unintentional injuries, including drowning, fires, and accidental firearms deaths, account for a large number of adolescent deaths.3 Alcohol and drugs are thought to be related to a considerable proportion of these fatalities.4 We would like to add to the list of practices causing unintentional injuries in adolescents a new game that causes repeated syncopal events.

We could not find any previous reports of such injurious games in the medical literature.

Section snippets

Case report

A 12-year-old boy with a medical history of mild asthma was brought to the emergency department by his father because of an episode of unconsciousness that lasted approximately 4 minutes. The patient did not recall any aura before his collapse and did not remember the events preceding his loss of consciousness. According to the history that was provided by his father, the patient collapsed while playing outdoors with his peers, who did not observe any tonic or clonic movements, change of facial

Discussion

In the United States, a teenager attempts suicide every 78 seconds, commits suicide every 90 minutes, dies in an accident every 20 minutes, and is murdered every 90 minutes.5 Mortality statistics represent only one aspect of adolescent health status. For every fatal injury, approximately 41 injuries require hospitalization, and at least 1,100 injuries are evaluated in an ED. For every fatality from a motor vehicle crash, there are more than 100 injuries. For every gun-related death, there are 5

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*

Address for reprints: Gil Z. Shlamovitz, MD, Department of Pediatrics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel; E-mail [email protected].

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