Validation of a computerized scoring system for foreign body aspiration: An observational study

Abstract

Objective The diagnosis of foreign body aspiration (FBA) is challenging. In a previous study, we developed a computerized scoring system (CSS) to support decision‐making. In the present study, we aimed to validate it on a further cohort. Study Design In this observational study, 100 children referred to the emergency department of a tertiary pediatric hospital for suspected FBA and treated according to standard protocol, were assigned a probability score using the CSS, between 0 and 1 (0, very low probability; 1, very high). The diagnosis of FBA was based on bronchoscopy, and if discharged without bronchoscopy, determined via telephone questionnaire, 4 to 6 months after discharge, supplemented by clinical re‐evaluation and bronchoscopy, if respiratory symptoms persisted. Results Thirty‐five out of 100 children (35%) underwent bronchoscopy with 12 of 35 (34%) positive for FBA. Sixty‐five patients were discharged without bronchoscopy and completed a telephone questionnaire. Seven patients required clinical re‐evaluation for persistent respiratory symptoms, in two out of them, additional bronchoscopies were performed and were negative. The CSS median probability score was 0.94 in patients with FBA, as compared to 0.73 in patients without FBA (P = .007). The CSS area under the receiver operating curve was 0.74. At a probability score threshold of 0.6, the sensitivity and specificity were 100% and 41%, respectively. Conclusion The present validation study suggests a high sensitivity of the CSS for the identification of FBA in children. We suggest that it might aid decision‐making with regard to the need for bronchoscopy in children presenting to the emergency room.

A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a retrospective cohort study

“…It showed a sensitivity and specificity of 95 and 70%, respectively [ 25 ]. A recent validation of this score system on 100 children with suspected FBA showed sensitivity of 100% and specificity of 41% [ 26 ]. Scoring systems and clinical algorithms might contribute to decision-making for bronchoscopy in children presenting with suspected FBA.…”

Diagnostic Errors in Initial Misdiagnosis of Foreign Body Aspiration in Children: A Retrospective Observational Study in a Tertiary Care Hospital in China

“…Inexperienced clinicians may struggle to weigh the benefits of bronchoscopy against the risks associated with it. Scoring systems can help support clinicians with their decision-making (11,28,29).…”

Clinical Prediction Models for Suspected Pediatric Foreign Body Aspiration

“…Of these, 64 articles did not meet eligibility criteria and 7 were included in the systematic review. [31][32][33][34][35][36][37] Details of excluded studies are provided eTable 2 in the Supplement.…”

“…Of the included articles, 6 described newly developed CPMs [31][32][33][34][35]37 and 1 externally validated 1 of these models 36 (Table 1). No internal validation was performed in the model derivation studies.…”

“…No internal validation was performed in the model derivation studies. Multivariable logistic regression was used in 6 studies, [31][32][33][34][35][36] with 1 developing a decision tree algorithm 37 (Table 2).…”