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Foreign body aspiration in children: diagnosis and treatment
Adel K Ayed1, Abdul Mohsen Jafar, Abdulla Owayed
1Department of Surgery Faculty of Medicine, Kuwait University, P.O. Box 24923, 13110 Safat, Kuwait. adel@hsc.kuniv.edu.kw
Insights
Rigid bronchoscopy is a safe and definitive diagnostic tool for suspected foreign body aspiration in children. While symptoms and X-rays have limitations, this procedure successfully removed foreign bodies in most cases.
Area of Science:
- Pediatric Pulmonology
- Medical Diagnostics
- Otolaryngology
Background:
- Foreign body aspiration is a common pediatric emergency.
- Timely diagnosis and intervention are crucial to prevent complications.
Purpose of the Study:
- To evaluate the diagnostic value of clinical symptoms, physical examination findings, and chest radiography in suspected foreign body aspiration.
- To determine the efficacy and safety of rigid bronchoscopy in pediatric patients.
Main Methods:
- Retrospective review of 235 children aged 7 months to 15 years undergoing bronchoscopy for suspected foreign body aspiration.
- Analysis of the diagnostic accuracy of presenting symptoms (choking, coughing), chest X-rays, and auscultation.
- Assessment of the success rate and complication rate of rigid bronchoscopy.
Main Results:
- High sensitivity for choking (82%) and coughing (80%), but low specificity.
- Chest radiography sensitivity was 66% and specificity 51%.
- Asymmetric auscultation showed 80% sensitivity and 72% specificity.
- Combination of history, signs, and radiography yielded 61% sensitivity and 83% specificity.
- Foreign bodies were identified and removed in 87.7% of cases.
- Rigid bronchoscopy was successful in 99% of cases with minimal complications.
Conclusions:
- Rigid bronchoscopy is the gold standard for diagnosing and treating foreign body aspiration in children.
- Asymmetric auscultation is a more specific indicator than patient history or chest X-rays.
- Combining clinical and radiological findings improves diagnostic specificity.
Abstract:
A total of 235 children, aged between 7 months and 15 years had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of symptoms, signs, and chest x-rays, and rate of negative bronchoscopy. The sensitivity of choking and coughing was high (82% and 80%), but the specificity was poor (37% and 34%). The sensitivity of a chest radiograph was 66%, the specificity was 51%. The sensitivity of asymmetric auscultation was 80% and specificity was 72%. The sensitivity and specificity of combination of symptoms, signs and abnormal chest radiograph was 61% and 83%, respectively. In 206 (87.7%) children a foreign body was identified and extracted. The remaining 29 patients (12.3%) had negative bronchoscopy. A wide variety of objects was recovered, the most common being seeds and peanuts. Foreign bodies were in the right and left main bronchus in 72 (35%), 50 (24.3%) cases, respectively, while in the remaining 84 cases, the foreign bodies were in other parts of the respiratory tree. In 204 (99%) patients with foreign body aspiration, the foreign bodies were removed successfully using a rigid bronchoscopy. Minor complications like subglottic edema and bronchospasm occurred in 4 children. In conclusion, rigid bronchoscopy is a safe procedure and the only tool that will give certainty about the correct diagnosis of foreign body aspiration in children. Asymmetric auscultation is more specific than history and chest radiograph. The combination of history, clinical signs and radiological signs are more specific than each one separately.