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Many Doctors Unaware of Deadly 'Choking Game'

Dozens of teens have died trying to achieve euphoric state, experts warn

MONDAY, Dec. 14 (HealthDay News) -- Almost a third of U.S. doctors have never heard of the "choking game" played by many teens, nor can they spot the tell-tale signs of the potentially lethal past-time.

Also known as the "blackout game," "pass-out game," "scarf game" and "space monkey," among other monikers, the activity involves intentionally trying to strangle oneself or another, using hands or some sort of noose to briefly achieve an euphoric state.

The "game" can also cause seizures, headaches, bone breaks and brain injury -- if not death.

A survey in the January issue of Pediatrics, which was published online Dec. 14, reports that almost one-third of family doctors and pediatrics are unaware of the "game." And although two-thirds of physicians said the issue should be discussed during office visits, only 2 percent reported actually having done so.

"Myself having seen three to four kids affected by this, it seems to me if it's preventable and it causes death, it should be talked about," said Dr. Nancy Bass, senior author of the paper and an associate professor of pediatrics and neurology at Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center in Cleveland.

Bass had not heard of the game at the time she saw her first choking-game patient, she said.

"There needs to be a more standardized approach to education [of doctors]," said study first author Dr. Julie McClave, a pediatric resident at Rainbow Babies. "Hopefully by giving more information about warning signs and how prevalent this is in adolescents, more physicians will be aware."

According to McClave, warning signs parents and physicians should be aware of include bruise marks or red marks around the neck; severe frequent headaches; blood vessel breaks on the face or eyes; red eyes; aggressive behavior or a change in behavior; unusual demands for privacy, such as locked bedroom doors; and wear marks on furniture, such as bunk beds or closet rods.

A report released earlier this year from the U.S. Centers for Disease Control and Prevention (CDC) found that, between 1995 and 2007, at least 82 youths died from playing the "choking game."

Prevalence data indicate that 11 to 20 percent of teenagers have played the game, said McClave.

"That's high and more prevalent than many physicians realize," she said.

"The concern I have is that . . . this is much more prevalent and the death numbers are even higher than we in the medical profession know," Bass added.

This may be confounded by the fact that many casualties from the "game" may be erroneously attributed to suicide or unintentional choking.

This survey of 163 pediatricians and family doctors revealed that more than 68 percent had heard of the choking game, the majority of those (61.3 percent) through popular news sources, indicating they had only a superficial knowledge of the phenomenon.

General practitioners were more likely to know of the game than pediatricians.

Not many doctors said they had actually seen a patient who had played the game although, the authors stated, this doesn't match up with prevalence data, suggesting that at least some physicians are missing cases.

Some experts questioned whether the doctor's office was actually the right place to make a dent in choking game statistics.

"The odds of an appointment being scheduled with a physician when the adolescent has physical evidence is not likely (unless the parent notices something is up and brings the adolescent in to be checked out)," said Dr. Karen Sheehan, medical director of the Injury Prevention and Research Center at Children's Memorial Hospital in Chicago. "I think physicians need to screen for it by asking the adolescent as they would any other risky behaviors -- drinking, smoking, sexual activity," she added.

"Primary care physician time is always limited. I really wonder if that's the best venue," added Dr. G. Patricia Cantwell, professor and chief of pediatric critical care medicine at the University of Miami Miller School of Medicine. "Pediatricians and family practitioners can [also] play an active role in the community to get some of these things accomplished." That could include public service messages and messages in school settings.

More information

There's more on the choking game at the U.S. Centers for Disease Control and Prevention.

SOURCES: Nancy Bass, M.D., associate professor, pediatrics and neurology, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland; Julie McClave, M.D., pediatric resident, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland; G. Patricia Cantwell, M.D., professor and chief, pediatric critical care medicine, University of Miami Miller School of Medicine; Karen Sheehan, M.D., medical director, Injury Prevention and Research Center, Children's Memorial Hospital, Chicago; January 2009 Pediatrics

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