Related Experiment Video
Updated: Dec 5, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Yield of preoperative findings in pediatric airway foreign bodies - A meta-analysis
Gil Zoizner-Agar1, Sabah Merchant1, Binhuan Wang2
1New York University School of Medicine, Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, New York, NY, USA.
Insights
Foreign body aspiration in children presents diverse symptoms. This meta-analysis provides diagnostic values for pre-procedural findings to aid decisions on bronchoscopy, improving pediatric airway foreign body management.
Area of Science:
- Pediatric Pulmonology
- Medical Diagnostics
- Systematic Review & Meta-Analysis
Background:
- Foreign body (FB) aspiration is a critical cause of pediatric illness and death.
- Clinical presentation of airway FB aspiration is variable, complicating diagnostic decisions.
- Bronchoscopy, the gold standard, involves risks and general anesthesia, necessitating careful pre-procedural evaluation.
Purpose of the Study:
- To analyze the diagnostic values of various pre-procedural findings in pediatric patients with suspected airway foreign bodies.
- To enhance clinical decision-making regarding the necessity of bronchoscopy.
Main Methods:
- A systematic review and meta-analysis of studies published in the last 19 years.
- Searched PUBMED, EMBASE, and Cochrane Review databases for studies reporting pre-procedural findings in pediatric bronchoscopies.
- Calculated cumulative weighted prevalence, sensitivity, specificity, and predictive values for individual findings and the "classic triad".
Main Results:
- Fifteen retrospective studies involving 5606 pediatric patients were included.
- No single pre-procedural finding demonstrated both positive and negative predictive values exceeding 50%.
- The "classic triad" (acute event history, wheezing, unilateral decreased breath sounds) showed 90% specificity but only 35% sensitivity.
Conclusions:
- Pre-procedural findings for airway foreign body aspiration are highly heterogeneous, making treatment guidance challenging.
- This meta-analysis offers cumulative metrics for individual findings to optimize patient-specific decision-making.
- Enhanced future data reporting is crucial for utilizing combined findings to refine management strategies.
Importance:
Foreign body (FB) aspiration into the airway is a significant cause of pediatric morbidity and mortality, yet the clinical presentation is diverse and dynamic. There are conflicting recommendations which pre-procedural findings support performing a bronchoscopy, the gold standard for diagnosis and removal of FBs, however a procedure that entails general anesthesia and possible risks.
Objective:
Decision whether to proceed to a bronchoscopy may be challenging. Our goal was to enhance decision-making by analyzing the diagnostic values of the different pre-procedural findings in this setting.
Data Sources:
A comprehensive search was performed in PUBMED, EMBASE and Cochrane Review databases to find studies from the last 19 years that reported pre-procedural history, physical examination and radiological findings in patients who had bronchoscopies.
Study Selection:
Studies were included of pediatric populations if they contained bronchoscopy results (positive and negative for foreign body) with a breakdown according to pre-intervention findings.
Data Extraction And Synthesis:
Titles and abstracts retrieved from our search were screened. Thereafter, full-texts were carefully reviewed and selected for inclusion if the aforementioned criteria were met. PRISMA guidelines for systematic review and meta-analyses were followed.
Main Outcome(S) And Measure(S):
Cumulative weighted prevalence, sensitivity, specificity, positive and negative predictive values of each pre-procedural finding were calculated, as well as for the "classic triad" (history of an acute event, wheezing, and unilateral decreased breath sounds). Calculation for other combinations of findings, or optimally, constructing a weighted score based on all the findings for each specific patient were not possible to perform, as the specific data breakdown is rarely reported.
Results:
Fifteen studies met inclusion criteria, totaling 5606 patients who underwent bronchoscopies. All studies but one were single center based and all except one were retrospective. No single finding has both positive and negative predictive values over 50%. The "classic triad" has 90% specificity, however only 35% sensitivity.
Conclusions:
The data is very heterogeneous with regard to pre-procedural findings and how best to guide treatment according to them. This meta-analysis provides cumulative weighted metrics for each finding, to optimize decision-making for the individual patient. Future reporting of data should be enhanced, so that combinations of findings for a specific patient can be used to optimize management.
Level Of Evidence:
4.
Related Concept Videos
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques