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Predictors of Foreign Body Aspiration in Children
Jacquelyn R Sink1, Dennis J Kitsko2, Matthew W Georg2
1UPMC Medical Education Preliminary Year Residency Program, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania, USA.
Insights
In children with suspected foreign body aspiration, radiologic findings strongly suggest the need for endoscopy. A clear history or physical exam finding makes foreign body aspiration less likely.
Area of Science:
- Pediatric Pulmonology
- Medical Diagnostics
- Emergency Medicine
Background:
- Foreign body aspiration in children presents with diverse clinical manifestations.
- Accurate diagnosis is crucial for timely intervention and preventing complications.
Purpose of the Study:
- To evaluate the diagnostic accuracy of patient history, physical examination, and radiologic studies in identifying foreign body aspiration in pediatric patients.
Main Methods:
- A retrospective chart review of 102 children who underwent endoscopy for suspected foreign body aspiration.
- Analysis included symptoms, physical exam findings, radiologic results, and endoscopy outcomes.
- Sensitivity, specificity, and predictive values were calculated for various diagnostic components.
Main Results:
- Foreign bodies were confirmed in 68% of cases, with seeds and nuts being most common.
- Cough (88%), choking/gagging (67%), and wheezing (57%) were the most frequent symptoms.
- Any radiologic abnormality had 61% sensitivity and 77% specificity; combined history, exam, and radiograph were 46% sensitive and 79% specific.
Conclusions:
- The presence of any abnormal radiologic finding in children with suspected foreign body aspiration warrants further investigation with endoscopy.
- While history and physical exam findings can be variable, their absence is associated with a lower probability of foreign body aspiration.
Objectives:
To examine the sensitivity and specificity of history, physical examination, and radiologic studies as predictors of foreign body aspiration in children.
Study Design:
Case series with chart review.
Setting:
Tertiary care children's hospital.
Subjects And Methods:
Medical records were reviewed for 102 children who presented to our institution from 2006 to 2013 with suspected foreign body aspiration and who underwent endoscopy. Data included symptoms, physical examination, radiologic, and endoscopy findings. Descriptive statistics, sensitivity and specificity, and univariate and multivariable analyses were performed.
Results:
A total of 102 patients were included (62% male). The mean age was 3.3 years (SD, 3.7). A foreign body was identified on endoscopy in 69 cases (68%). The most common presenting symptoms were cough (88%), choking/gagging (67%), and wheezing (57%). Decreased breath sounds and wheezing on examination were independently associated with increased odds of foreign body. The most common abnormal radiographic finding was air trapping (33%). The most frequent items retrieved were fragments of seeds and nuts (49%). There were no serious complications related to endoscopy. The sensitivity and specificity of any finding on history, physical examination, and imaging were 100% and 3%, 90% and 33%, 61% and 77%, respectively. Having a positive history, examination, and chest radiograph combined was 46% sensitive and 79% specific.
Conclusions:
Patients with airway foreign bodies have varied presentations. The presence of any radiologic finding suggests that endoscopy should be performed, as a foreign body is probable. The absence of any history or physical examination finding was associated with a low likelihood of a foreign body.
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