Clinical Insights into Pediatric Foreign Bodies: A Cluster Analysis of Symptoms and Assessment of Caregiver Reports

Abstract

Foreign body (FB) events are prevalent in emergency room consultations, with 107,000 cases annually in the United States (80% in the pediatric population). They result in an estimated 1,500 mortalities each year. A cross-sectional study between February 2008 and September 2015, employing hierarchical cluster analysis of signs and symptoms at presentation to the emergency room was performed. Sensitivity, specificity, and decision curve analysis for a caregivers’ report of events was calculated with confirmed FB diagnosis as a reference. 1,032 patients were included, 886 suspected ingestion and 166 suspected aspiration patients. For aspiration, a higher frequency of complications (14.3%) and mortalities (4.76%) were observed in the cluster exhibiting most respiratory symptoms. For ingestion, associations for complications (3.6%), longer stays (mean, 55.1 hours) and mortality (n = 2) were identified in a cluster with respiratory pattern. Increased respiratory symptoms at presentation are potential predictors of severe outcomes, intuitively in cases of aspiration, but notably in ingestion. Although definitive diagnostic procedures are still necessary, the severity of respiratory symptoms helps identify patients at risk of complications and helps prioritize resources when necessary. Caregivers’ certainty of FB aspiration yielded a 72.5% sensitivity and 45.4% specificity. Certainty of FB ingestion resulted in 86.8% sensitivity and 19.8% specificity.