The role of economics and weekend meals in impacted fish bone occurrence in Central Israel

Background: The fish-eating habits of Israelis who present with impacted fish bones in the aerodigestive tract are unknown. Objectives: To retrospectively investigate the relation between an impacted fish bone in the aerodigestive tract, the species of fish, and the place of occurrence in an Israeli population. Methods: The current prospective observational study included all patients with aerodigestive impacted fish bones who were treated in our emergency department from 1 September 2008 to 30 September 2009. The data retrieved from their medical records included age, gender, place of event (at home or elsewhere), species of fish, and method of removing the bone. Results: A total of 108 patients - aged 1.5-87 years (median 48 years), 52.8% female - met the study criteria. Most (87%) of the events occurred at home, and 50.9% occurred during the weekend (Friday-Saturday). The bones were from lowpriced fish (e.g., carp, hake) in 62% of the cases, high-priced fish (e.g., salmon, red snapper) in 30.5%, and of unknown species in 10.2%. The proportion of cases in which the fish bone was from a high-priced fish eaten out of the home was significantly higher than the cases in which a low-priced fish was eaten at home (64.3% vs. 22.3%, P = 0.04). One hundred bones were removed during direct oral inspection and 8 bones were removed under general anesthesia by endoscopy. Conclusions: Most fish bone impactions in the aerodigestive tract in central Israel involve low-priced fish and take place at home over the weekend.