Factors predicting early diagnosis of foreign body aspiration in children

To analyze the clinical spectrum of tracheobronchial foreign bodies in children and explore the clinical features which could facilitate early diagnosis.

We retrospectively studied pediatric patients who had aspirated foreign bodies over the past 5 years from July 1998 to July 2003 in a tertiary children hospital in northern Taiwan. Patients were divided into 2 groups according to the elapsed time from aspiration to definite diagnosis as early (< or =24 hours after aspiration) and late diagnosis (>24 hours after aspiration). The 2 groups were compared for clinical features, radiological findings, and the influence of morbidity and mortality of early- and late-diagnosed foreign body aspiration (FBA).

A total of 53 patients (27 boys, 26 girls) were recruited with a median age of 25.4 +/- 21.3 months. FBA was suspected by the parents in 59% of patients. Sudden onset of cough (72%), dyspnea (64%), and wheeze (60%) were the predominant symptoms and signs. Nuts and peanut (59%) were the most common foreign bodies aspirated. Obstructive emphysema (53%) and normal chest radiograph (34%) were the most frequent radiological findings. Parenchymal consolidation with pneumonia was predominant in the group of late diagnosis (P < 0.05). Bronchial asthma (n = 9), pneumonia (n = 8), and common cold (n = 5) were the most common mistaken diagnoses. Witnessing of choking episode was the most important historical event to pinpoint an early diagnosis of FBA in children (P = 0.002).

In children with an unequivocal choking event while eating even with normal physical and radiographic findings, FBA requires to be excluded by thorough investigations in such instances. Similarly, in toddlers with unexplained persistent cough with refractory parenchymal infiltrates, unrecognized FBA should also be considered. A witnessed choking event is the most important historical information to make an early diagnosis of FBA.