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A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a
Nader A Fasseeh1, Osama A Elagamy2, Alaa H Gaafar3
1Pediatric Respiratory and Allergy Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Diagnosing foreign body aspiration in children can be challenging. A new scoring system and clinical algorithm accurately predict the need for bronchoscopy, improving diagnostic decisions.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Diagnostic Imaging
Background:
- Foreign body aspiration is a common emergency in children, often difficult to diagnose via physical exam or chest X-ray alone.
- A suggestive patient history is crucial for identifying aspirated foreign bodies in pediatric cases.
- Current diagnostic methods lack definitive sensitivity and specificity, necessitating improved predictive tools.
Purpose of the Study:
- To evaluate the diagnostic accuracy of symptoms, physical examination, and radiological findings for foreign body aspiration in children.
- To develop a predictive scoring system and clinical algorithm to guide bronchoscopic investigation for suspected foreign body aspiration.
Main Methods:
- Retrospective cohort study of 203 children under 16 with suspected foreign body aspiration undergoing bronchoscopy.
- Data collected included demographics, symptoms, physical findings, radiological features, and bronchoscopy outcomes.
- Multivariable binary logistic regression analysis was used to predict foreign body aspiration.
Main Results:
- The predictive model demonstrated high accuracy (86.2%), sensitivity (90.6%), and specificity (76.6%) for foreign body aspiration (AUC=0.911).
- A weighted risk score with a cut-off >2 showed good discrimination (AUC=0.879), with 79.9% sensitivity and 84.4% specificity.
- A clinical algorithm was recommended based on these findings.
Conclusions:
- The developed scoring system and algorithm can aid in deciding the necessity and type of bronchoscopy for children with potential foreign body aspiration.
- Further prospective multicenter studies are recommended to validate the proposed scoring system.
- This tool aims to optimize diagnostic pathways and resource allocation in pediatric respiratory emergencies.
Background:
Cases of foreign body aspiration in children may be encountered in emergency departments. A suggestive history is important in diagnosing aspirated foreign body owing to the difficulty in making a diagnosis on the basis of an abnormal physical examination or chest radiography alone. The aim of this study was to examine the sensitivity and specificity of the presenting symptoms, physical examination, and radiologic findings as predictors of foreign body aspiration in children. In addition, a feasible simple algorithm with a scoring system was generated to indicate bronchoscopic investigation.
Methods:
In a retrospective cohort, medical records of patients aged less than 16 years with suspected foreign body aspiration who underwent flexible or rigid bronchoscopy were included. Data including age, sex, symptoms, physical examination findings, radiological features, nature and location of the foreign body, and outcome of the bronchoscopy were collected, and multivariable binary logistic regression analysis was employed for prediction of foreign body aspiration.
Results:
A total of 203 children were included, and the model showed excellent discrimination power for positive foreign body aspiration (area under the curve = 0.911) with an accuracy, sensitivity, and specificity of 86.2, 90.6, and 76.6%, respectively. The total weighted risk score at a cut-off > 2 showed a significant good power of discrimination (area under the curve = 0.879), with a sensitivity of 79.9% and specificity of 84.4%. Accordingly, a clinical algorithm was recommended.
Conclusions:
The proposed scoring system and clinical algorithm might help in decision making with regard to the need and type of bronchoscopy in children presenting with potential foreign body aspiration. However, further prospective multicenter studies should be conducted to validate this scoring system.
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