Predictors of Positive Bronchoscopy in Children with Suspected Foreign Body Aspiration: A Retrospective...

Foreign body aspiration (FBA) is a common pediatric emergency, and bronchoscopy remains the diagnostic and therapeutic gold standard despite its invasive nature and associated procedural risks. This study aimed to evaluate the clinical and radiographic factors associated with foreign body detection during bronchoscopy in children undergoing bronchoscopy for suspected FBA.

This single-center, retrospective, cross-sectional study included children aged 0-18 years who underwent bronchoscopy for suspected FBA at a tertiary pediatric emergency department between January 2010 and January 2026. Of 120 eligible patients, 25 were excluded because of incomplete medical records, resulting in a final cohort of 95 children. Predictors of bronchoscopy positivity were evaluated using Firth's penalized logistic regression because of outcome imbalance and separation in some radiographic variables.

The median age was 19.0 months (interquartile range [IQR] 14.0-26.0), and 55 patients (57.9%) were male. Foreign bodies were identified in 81 children (85.3%), whereas bronchoscopy was negative in 14 (14.7%). Air trapping on chest radiography showed the strongest association with foreign body detection during bronchoscopy (adjusted OR 33.80, 95% CI 4.19-4389.05; p < 0.001), although the wide confidence interval indicates substantial statistical uncertainty. A normal chest radiograph was associated with a lower likelihood of foreign body detection (OR 0.10, 95% CI 0.02-0.34; p < 0.001). Nevertheless, normal radiographic findings did not exclude FBA, as 24.7% of children with bronchoscopically confirmed FBA had normal chest radiographs.

Among children undergoing bronchoscopy for suspected FBA, radiographic air trapping showed the strongest association with foreign body detection, although this finding should be interpreted cautiously because of substantial statistical uncertainty. A normal chest radiograph could not reliably exclude FBA, and individual clinical findings showed limited discriminatory value. These findings apply only to children who had already been selected for bronchoscopy and support integrating clinical history, physical examination, and imaging findings when evaluating such patients.