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A new clinical algorithm scoring for management of suspected foreign body aspiration in children
Ibrahim A Janahi1,2, Shabina Khan3, Prem Chandra4
1Pediatric Pulmonology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar. ijanahi@hamad.qa.
Insights
Diagnosing foreign body aspiration (FBA) in children requires a high index of suspicion. This study developed a clinical algorithm and scoring system to accurately predict FBA likelihood based on historical, physical, and radiological findings.
Area of Science:
- Pediatric Pulmonology
- Medical Diagnostics
- Respiratory Medicine
Background:
- Foreign Body Aspiration (FBA) poses a significant risk to children, with potential for severe consequences due to diagnostic delays.
- Subtle clinical presentations and ambiguous radiological findings often complicate FBA diagnosis in pediatric patients.
Purpose of the Study:
- To identify key clinical indications for bronchoscopy in pediatric FBA cases.
- To evaluate significant predictors of FBA using historical, physical, and radiological data.
Main Methods:
- Retrospective observational study of 300 children with suspected FBA from 2001-2011.
- Analysis of presenting history, physical examination, radiological, and bronchoscopic findings.
Main Results:
- Witnessed choking, noisy breathing, new wheeze, abnormal chest X-rays, and unilateral reduced air entry were significant predictors of FBA.
- The presence of three or more risk factors significantly increased the likelihood of confirmed FBA.
- A clinical algorithm demonstrated good discriminative ability (AUC 0.76) for predicting FBA.
Conclusions:
- A high index of suspicion is crucial for diagnosing airway foreign bodies in children.
- The proposed clinical algorithm and scoring system can aid physicians in accurately predicting FBA likelihood.
Background:
Foreign Body Aspiration (FBA) is a serious problem in children and delays in diagnosis and management can be devastating. The history is often vague, with subtle physical and chest radiograph abnormalities. This study aims to determine the indications for bronchoscopy in children with suspected FBA and evaluate the key clinical and statistically significant predictors of FBA, based on the patients' historical, physical and radiological findings at presentation.
Methods:
This is a retrospective observational study, including patients who were admitted between January 2001 to January 2011 with suspected FBA. Their presenting history, physical exam, radiological and bronchoscopic findings were analyzed.
Results:
Three hundred children with a mean age of 2.1 ± 1.7 years were included. In children with both abnormal physical and radiological findings, 47.2% had proven FBA. If either was abnormal, the likelihood reduced to 32-33.3%; if both were normal, only 7.4% had a FB. Witnessed choking (adjusted OR 2.1, 95% CI 1.03-4.3; P = 0.041), noisy breathing/stridor/dysphonia (adjusted OR 2.7, 95% CI 1.2-6.2; P = 0.015), new onset/recurrent /persistent wheeze (adjusted OR 4.6, 95% CI 1.8-11.8; P = 0.002), abnormal radiological findings (adjusted OR 4.0, 95% CI 1.9-8.5; P < 0.001), and unilateral reduced air entry (adjusted OR 2.9, 95% CI 1.5-5.5; P = 0.001) were significant predictors of FBA (P < 0.05). When three or more risk factors were present, the cumulative proportion of children with proven FBA increased significantly. The discriminative ability of the model was found to be good; the area under the ROC curve value was 0.76 (95% CI 0.70, 0.82). The predicted cutoff score derived using ROC analysis was found to co-relate well with known clinically significant predictors of FBA. This supports our algorithm and scoring system.
Conclusions:
A high index of suspicion is required in diagnosing airway FB. Our proposed clinical algorithm and scoring system hopes to empower physicians to accurately predict patients with a high likelihood of FBA.