Management of suspected foreign body aspiration in children

Area of Science:

• Pediatric Otolaryngology
• Respiratory Medicine

Background:

• Foreign body (FB) aspiration is a common pediatric concern.
• Clinical or radiological findings guide management decisions for suspected FB aspiration.
• Uncertainty exists in managing cases with suggestive history but no definitive signs.

Purpose of the Study:

• To determine current consultant practices in the UK for managing children with suspected foreign body aspiration but no clinical or radiological evidence.
• To understand the consensus on diagnostic and therapeutic interventions in ambiguous cases.

Main Methods:

• A postal questionnaire was distributed to consultants of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS).
• The survey assessed preferred management strategies (bronchoscopy, observation, discharge) based on FB type (organic vs. inorganic) in cases lacking objective findings.
• A 63% response rate was achieved from 563 distributed questionnaires.

Main Results:

• For suspected organic foreign bodies, 52% of consultants opted for immediate bronchoscopy, 38% for observation, and 10% for discharge.
• For suspected inorganic foreign bodies, 35% preferred bronchoscopy, 42% observation, and 23% discharge.
• The majority of consultants favored admission, with a tendency towards bronchoscopy for organic FBs and observation for inorganic FBs.

Conclusions:

• Management strategies for pediatric foreign body aspiration with suggestive history but no objective findings show variability among UK consultants.
• A preference exists for more invasive management (bronchoscopy) with organic foreign bodies compared to inorganic ones.
• Discharging patients without clear justification in these ambiguous cases may pose risks and is considered potentially unacceptable by many.