Foreign body inhalation in the pediatric population: Lessons learned from 106 cases

Rizk, Habib G.; Rassi, Simon

doi:10.1016/j.anorl.2011.01.004

Cited by 34 publications

(38 citation statements)

References 21 publications

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“…The decision is often based wholly on the discretion of the treating physician. Many previous studies have attempted to establish the criteria for bronchoscopy in children with FBA by drawing conclusions from the presenting history, examination and chest radiograph findings of patients with bronchoscopically proven FBA [2, 5, 17–20]. …”

Section: Discussionmentioning

confidence: 99%

A new clinical algorithm scoring for management of suspected foreign body aspiration in children

et al. 2017

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BackgroundForeign Body Aspiration (FBA) is a serious problem in children and delays in diagnosis and management can be devastating. The history is often vague, with subtle physical and chest radiograph abnormalities. This study aims to determine the indications for bronchoscopy in children with suspected FBA and evaluate the key clinical and statistically significant predictors of FBA, based on the patients’ historical, physical and radiological findings at presentation.MethodsThis is a retrospective observational study, including patients who were admitted between January 2001 to January 2011 with suspected FBA. Their presenting history, physical exam, radiological and bronchoscopic findings were analyzed.ResultsThree hundred children with a mean age of 2.1 ± 1.7 years were included. In children with both abnormal physical and radiological findings, 47.2% had proven FBA. If either was abnormal, the likelihood reduced to 32–33.3%; if both were normal, only 7.4% had a FB. Witnessed choking (adjusted OR 2.1, 95% CI 1.03–4.3; P = 0.041), noisy breathing/stridor/dysphonia (adjusted OR 2.7, 95% CI 1.2–6.2; P = 0.015), new onset/recurrent /persistent wheeze (adjusted OR 4.6, 95% CI 1.8–11.8; P = 0.002), abnormal radiological findings (adjusted OR 4.0, 95% CI 1.9–8.5; P < 0.001), and unilateral reduced air entry (adjusted OR 2.9, 95% CI 1.5–5.5; P = 0.001) were significant predictors of FBA (P < 0.05). When three or more risk factors were present, the cumulative proportion of children with proven FBA increased significantly. The discriminative ability of the model was found to be good; the area under the ROC curve value was 0.76 (95% CI 0.70, 0.82). The predicted cutoff score derived using ROC analysis was found to co-relate well with known clinically significant predictors of FBA. This supports our algorithm and scoring system.ConclusionsA high index of suspicion is required in diagnosing airway FB. Our proposed clinical algorithm and scoring system hopes to empower physicians to accurately predict patients with a high likelihood of FBA.

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Section: Discussionmentioning

confidence: 99%

A new clinical algorithm scoring for management of suspected foreign body aspiration in children

et al. 2017

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“…It is probably not a worthwhile investigation if a preceding chest radiograph suggests the presence of a FB'' Blazer, 1980 [18] ''chest fluoroscopy contributed to the dx in 90% of cases of bronchial FB but only 32% in the laryngotracheal area'' do not always feel safe with a negative finding using a flexible endoscope when a lot of secretions are present [24], none have reported cases of missed FB using the flexible later found using the RB. In our series and others, a RB did not follow negative flexible bronchoscopy unless the need for biopsy or palpation arose.…”

Section: Articlementioning

confidence: 97%

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Cavel

Bergeron

Garel

et al. 2012

International Journal of Pediatric Otorhinolaryngology

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“…In the literature, air trapping was the most commonly observed abnormality, accounting for 60% of cases compared to only 7.4% in our study [12][13][14][15]. This radiological abnormality was mainly observed in early-diagnosed forms of FBA, while atelectasis and pneumonia were more often seen when FBA was diagnosed later [16].…”

Section: Discussionmentioning

confidence: 76%

“…In a series of 310 children with FBA, Cutrone et al [12] reported that diagnosis was made after a week in 29% of cases, and after 30 days in 10% of cases. Similarly, Rizk et al [13] showed that 29% of children consulted within 24 hours after the accident, and 49% consulted after more than 72 hours. In our series, parents consulted within the first 72 hours after inhalation in 47.6% of cases, and in 23.8% of cases, diagnosis was delayed by more than a month; this is a high percentage compared to that reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Foreign body inhalation in Tunisian children: Experience of a pediatric respiratory diseases department

2015

Adv Ped Res

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Background:The aim of the present study was to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Tunisian children. Methods: This was a retrospective study of 76 children with foreign body aspiration who were admitted to our department for flexible and/or rigid bronchoscopy between January 2002 and January 2013. Results:The median age of the children was 2.8 years (range: 1.58-6 years). Of these, 61.6% were aged between one and three years. The aspirated foreign bodies were nuts and seeds in 44.64 % of cases, with sunflower seeds representing 19.64% of these cases. Scarf pins were the most frequent metallic foreign body in 7.9% of cases. Almost half of cases were presented within 72 hours of inhalation. Diagnosis of an inhaled foreign body was delayed by more than 30 days in 23.8% of cases. In 79.6% of subjects, a typical penetration syndrome was found on interviewing the parents. Chest X-ray was normal in 18.5% of cases. All children underwent flexible bronchoscopy first, or after rigid bronchoscopy. In 73 (96%) children, the foreign body was seen during flexible bronchoscopy. Eleven foreign bodies (15.2%) were removed safely in our department, via the flexible bronchoscope under general anesthesia. Surgery for foreign body extraction, or for treatment of complications, was necessary in 21.05% of children. Conclusions: Inhalation of seeds and nuts by children is a serious problem. Education by physicians, and especially parents, is the main guarantor to significantly reduce morbidity and mortality in this pathology.

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Foreign body inhalation in the pediatric population: Lessons learned from 106 cases

Abstract: FB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology.

Cited by 34 publications

References 21 publications

A new clinical algorithm scoring for management of suspected foreign body aspiration in children

A new clinical algorithm scoring for management of suspected foreign body aspiration in children

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Foreign body inhalation in Tunisian children: Experience of a pediatric respiratory diseases department

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