Pediatric Foreign Body Aspiration Over 2 Decades: Clinical Features, Diagnostic Challenges, and Complications...

BACKGROUND Foreign body aspiration (FBA) is a leading cause of preventable injury and death in young children, yet diagnosis can be challenging because the choking event is not always witnessed or recognized and routine investigations have limited sensitivity. Long-duration data from Central-Eastern Europe are scarce. We characterized bronchoscopically confirmed pediatric FBA in a Polish tertiary center and factors associated with complications. MATERIAL AND METHODS In a single-center retrospective cohort, we studied children (<18 years) with a bronchoscopically confirmed foreign body admitted over 20.5 years (2001-2021). Categorical associations were tested with the chi-square, Fisher, or Fisher-Freeman-Halton exact test, and correlations with the Spearman coefficient. A multivariable logistic regression model examined factors associated with complications, with false-discovery-rate control. A 2-sided P<0.05 indicated significance. RESULTS We analyzed data from 254 children (median age 21 months; 60.6% boys). Feeding was the commonest circumstance (57.1%), and organic objects (predominantly nuts) accounted for 73.6%. The chest radiograph was normal in 16.1% and showed the classical triad in 7.5%. Rigid bronchoscopy was definitive in 90.6%, and complications occurred in 13.0%. In multivariable analysis, older age (OR 1.88, 1.18-2.98) and a prolonged or unknown interval to bronchoscopy (OR 2.75, 1.27-5.95) were independently associated with complications, whereas foreign body type was not (OR 1.02, 0.42-2.50). Bronchiectasis and fibrotic changes occurred almost exclusively with intervals exceeding 30 days or unknown. CONCLUSIONS Normal initial clinical and radiographic findings did not exclude FBA in this confirmed-case cohort. Complications were independently associated with older age and a longer or unknown interval to bronchoscopy rather than with foreign body type, although causality cannot be inferred.