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Clinical Prediction Models for Suspected Pediatric Foreign Body Aspiration: A Systematic Review and Meta-analysis
John J W Lee1, Justine Philteos1, Marc Levin1
1Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Insights
Existing clinical prediction models (CPMs) for pediatric foreign body aspiration (FBA) lack adequate validation and are at high risk of bias. Current models cannot reliably guide clinical decisions for FBA diagnosis in children.
Area of Science:
- Pediatric Pulmonology
- Clinical Decision Support
- Medical Informatics
Background:
- Clinical prediction models (CPMs) aim to aid in diagnosing pediatric foreign body aspiration (FBA).
- However, there is no established consensus on their clinical utility or indications for bronchoscopy.
- This study evaluates existing CPMs for FBA diagnosis in children.
Purpose of the Study:
- To systematically review and evaluate the performance of currently available CPMs for diagnosing FBA in children.
- To identify key predictors used in these models.
- To assess the risk of bias and validation status of existing CPMs.
Main Methods:
- A systematic literature search was conducted across multiple databases (Ovid MEDLINE, Embase, PubMed, Web of Science, CINAHL).
- Prediction model derivation and validation studies for pediatric FBA were included.
- Data extraction and synthesis followed established frameworks, including risk of bias assessment and meta-analysis of predictor variables and models.
Main Results:
- Seven studies (1577 patients) were included, with 6 model derivation and 1 validation study.
- Common predictors included air trapping, unilateral reduced air entry, witnessed choking, wheezing, and radiographic findings.
- Models showed variable performance (C statistic 0.74-0.88), with a pooled C statistic of 0.86.
- All included studies were at high risk of bias, primarily due to overfitting and lack of external validation.
Conclusions:
- Existing CPMs for pediatric FBA are significantly limited by high risk of bias and inadequate validation.
- No current CPM can be recommended for guiding clinical decision-making in FBA diagnosis.
- Future research must focus on developing and validating CPMs according to recognized methodological standards.
Importance:
Although various clinical prediction models (CPMs) have been described for diagnosing pediatric foreign body aspiration (FBA), to our knowledge, there is still no consensus regarding indications for bronchoscopy, the criterion standard for identifying airway foreign bodies.
Objective:
To evaluate currently available CPMs for diagnosing FBA in children.
Data Sources:
Performed in Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL database with citation searching of retrieved studies.
Study Selection:
Prediction model derivation and validation studies for diagnosing FBA in children were included. Exclusion criteria included adult studies; studies that included variables that were not available in routine clinical practice and outcomes for FBA were not separate or extractable.
Data Extraction And Synthesis:
We followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies and the Prediction Model Risk of Bias Assessment Tool framework. Data were pooled using a random-effects model.
Main Outcomes And Measures:
The primary outcome was the diagnosis of FBA as confirmed by bronchoscopy. Characteristics of CPMs and individual predictors were evaluated. The final model presentation with available measures of performance was provided by narrative synthesis. A meta-analysis of individual predictor variables and prediction models was performed.
Results:
After screening 4233 articles, 7 studies (0.2%; 1577 patients) were included in the final analysis. There were 6 model derivation studies and 1 validation study. Air trapping (odds ratio [OR], 8.3; 95% CI, 4.4-15.5), unilateral reduced air entry (OR, 4.8; 95% CI, 3.5-6.5), witnessed choking (OR, 3.1; 95% CI, 1.0-9.6), wheezing (OR, 2.5; 95% CI, 1.2-5.2), and suspicious findings suggestive of FBA on radiography (OR, 18.5; 95% CI, 5.0-67.7) were the most commonly used predictor variables. Model performance varied, with discrimination scores (C statistic) ranging from 0.74 to 0.88. The pooled weighted C statistic score of all models was 0.86 (95% CI, 0.80-0.92). All studies were deemed to be at high risk of bias, with overfitting of models and lack of validation as the most pertinent concerns.
Conclusions And Relevance:
This systematic review and meta-analysis suggests that existing CPMs for FBA in children are at a high risk of bias and have not been adequately validated. No current models can be recommended to guide clinical decision-making. Future CPM studies that adhere to recognized standards for development and validation are required.
