Tracheobronchial foreign body aspiration in children in Soweto, South Africa: A retrospective descriptive study

Airway foreign bodies are a common cause of accidental death in children. Tracheobronchial foreign body aspiration (FBA) can result in severe immediate and long-term complications if the foreign body is not identified and removed. Little is known about the burden of tracheobronchial FBA in the Soweto area, south of Johannesburg, South Africa. Objectives. To describe the burden and clinical characteristics of tracheobronchial FBA in hospitalised children in a tertiary-level hospital in Johannesburg.

This was a retrospective, single-centre, descriptive study of children aged <10 years who presented to Chris Hani Baragwanath Academic Hospital from 1 January 2011 to 31 December 2020. Children with FBA were identified from the paediatric pulmonology and paediatric surgery databases using the relevant International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), codes (T17.4 and T17.5). Clinical and radiological data were extracted from medical records and the databases.

Forty-seven children with FBA were identified during the study period. Overall, the incidence of FBA among children aged <10 years of age was 1.42 per 100 000 person-years (95.0% confidence interval 1.04 - 1.88). FBA occurred more commonly in males (66.0%; n=31), and the mean (standard deviation) age at presentation was 68 (28.2) months. Most of the children (42.6%) were in the 7 - <10-year age group, followed by the 5 - <7-year age group (27.7%). Chronic respiratory symptoms were reported in one-third of the children, and a history of witnessed FBA was reported in only 59.6% of cases. Inorganic foreign bodies (n=29; 61.7%) were aspirated more commonly than organic foreign bodies; these included metal objects such as pins or springs (21.3%), toy parts (17.0%), pen or pencil lids/stoppers (12.8%) and plastic objects (6.4%).

Our study highlights the fact that tracheobronchial FBA is prevalent in school-aged children, and public safety campaigns targeted at this age group are warranted. Furthermore, to prevent sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.

What the study adds. Our study demonstrated that tracheobronchial foreign body aspiration (FBA) was most prevalent in school-aged children (7 - <10 years of age), which is in contrast to studies that have reported a high prevalence in children aged <3 years. Chronic respiratory symptoms were reported in only a third of the children, and a history of witnessed FBA was reported in only 59.6%. Chest radiographs were normal in a high proportion of cases in which a chest radiograph was done (56.3%). Inorganic foreign bodies were aspirated more commonly than organic foreign bodies.Implications of the findings. Public safety campaigns should be targeted at school-aged children in Soweto, South Africa. Clinicians should investigate children with respiratory symptoms suggestive of FBA, even if a history is not forthcoming. Furthermore, to prevent long-term respiratory sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.