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Ten years of paediatric airway foreign bodies in Western Australia
Allison Reid1, Anton Hinton-Bayre1, Shyan Vijayasekaran1
1Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Insights
Diagnosing paediatric airway foreign body (PAFB) is challenging. While imaging like X-rays are not always helpful when symptoms and signs are present, they can aid diagnosis when only one is present, guiding treatment decisions.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Diagnosing paediatric airway foreign body (PAFB) lacks a definitive algorithm, leading to difficult clinical decisions.
- History and physical examination are often inconclusive, increasing risks of watchful waiting or rigid bronchoscopy (MLB).
- This study evaluates the predictive value of clinical data and investigations for PAFB detection.
Purpose of the Study:
- To assess the diagnostic utility of history, physical examination, and imaging in suspected paediatric airway foreign body cases.
- To determine the effectiveness of these methods in guiding decisions for rigid bronchoscopy (MLB).
Main Methods:
- Retrospective review of 127 children undergoing MLB for suspected PAFB (2007-2016).
- Analysis of epidemiological data, clinical history, physical examination findings, and radiological results.
- Correlation of pre-procedural data with MLB outcomes.
Main Results:
- Combined history, examination, and X-ray findings showed 87.7% sensitivity for PAFB detection during MLB.
- In patients with both symptoms and signs (n=96), chest X-ray did not significantly improve PAFB detection rates.
- Chest X-ray demonstrated low specificity (17%) but high sensitivity (88%) in symptom and sign-positive patients.
Conclusions:
- For children with both signs and symptoms of PAFB, X-ray findings offer limited assistance in decision-making.
- Positive imaging significantly increases the likelihood of PAFB when only a sign or symptom is present.
- CT scans can help rule out PAFB in low-suspicion cases, avoiding unnecessary anesthesia; public awareness on prevention is crucial.
Background:
Whenever a paediatric airway foreign body (PAFB) is suspected, decisions may be difficult without a clearly defined or accepted treatment algorithm. History and examination are commonly non-diagnostic and the risks associated with either watchful waiting or proceeding to MLB are significant. This paper reviews a 10 year cohort of suspected PAFBs for the predictive utility of history, examination and investigations and subsequent positive findings at MLB.
Objectives:
STUDY DESIGN: The medical records of 127 children who underwent MLB for suspected PAFB between 2007 and 2016 were examined. The data was retrospectively reviewed for epidemiological details, history, examination, radiological findings and MLB outcomes.
Results:
Sensitivity for PAFB on MLB with all three; history, examination and imaging (x-ray) positive for PAFB was 87.7%. Of the patients who were both symptom and sign positive (n = 96), chest x-ray findings did not significantly alter the chance of finding a PAFB. Chest x-ray had a low specificity (17%) in symptom and sign positive patients. Conversely, sensitivity of chest x-ray was high (88%), for symptom and sign positive patients.
Conclusions:
For a child with both signs and symptoms, xray is unlikely to assist in decision making around suspected PAFB. When only sign or symptom is present, positive imaging may significantly increase the chance that PAFB is the cause.For patients with a low suspicion of PAFB, consideration of a CT can be a helpful means of excluding a PAFB and avoiding an unnecessary general anaesthetic in this potentially high-risk group.A greater level of public awareness is needed with regards to appropriate food types for children and the importance of eating seated and supervised in order to reduce the risk of PAFB.
