Endobronchial foreign body in children: can it be predictable?

Foreign body aspiration (FBA) is a critical paediatric emergency that requires prompt recognition and management to avoid severe complications. Diagnosis is challenging due to variable clinical presentations, requiring a combination of history, physical examination, and imaging. Rigid bronchoscopy remains the gold standard for diagnosis and treatment but is associated with a significant proportion of negative procedures.

We conducted a retrospective, single-centre review of paediatric bronchoscopies for suspected FBA over 30 years at CHU UCL Namur, Godinne, Belgium. Clinical, radiological, and procedural data were analysed, including symptomatology, foreign body characteristics, and follow-up outcomes.

Among 99 bronchoscopies performed for suspected FBA, a foreign body was confirmed in 58 cases (59%). The highest incidence occurred in children aged 1-3 years (69%). Penetration syndrome was a strong predictor (sensitivity: 90%, Odds ratio (OR): 26.9; 95% CI:8.9-81.2, negative predictive value (NPV): 0.84). Asymmetric auscultation was the most discriminative clinical sign of FBA (specificity: 98%, OR: 42.9; 95% CI: 5.5-332.9, positive predictive value (PPV): 0.97). Unilateral hyperinflation was the most specific radiological sign (specificity: 88%, OR: 16.0; 95% CI: 5.4-47.5, PPV: 0.89). Organic foreign bodies, mainly nuts (74%), were the most common. Rigid bronchoscopy was used in 36% of cases, flexible in 37%, and both in the remaining cases. Complications occurred in 48% per-procedurally and 35% post-procedurally, but no fatalities were reported. Complete clinical recovery was achieved at 6-month follow-up.

Diagnosis of FBA relies on clinical examination, detailed medical history, and radiological findings, with both rigid and flexible bronchoscopy remaining essential for diagnosis and management.