Pediatric tracheobronchial foreign bodies: historical review from the Johns Hopkins Hospital

We investigated changing trends in pediatric tracheobronchial foreign body removal and resident experience from 1939 to 1991. We retrieved the records of 234 cases of tracheobronchial foreign body removal at Johns Hopkins. The mean number of cases per year was 5.9. The most common foreign bodies removed were peanuts, accounting for 38.9%. The average yearly incidence of pediatric tracheobronchial foreign bodies remained relatively constant during the period studied. Our data suggested little change in outcome or complications with the advent of optical telescopes in the mid-1970s, despite their great value in improved visualization. Resident experience and training were evaluated by the number of cases attended by each resident during his or her training. The number varied from 1 to 8 cases, not including experience acquired at our sister institutions. Although complete data could not be obtained in many of the older medical records, our review suggests that despite the advantage offered by the optical forceps technology, proper training and experience in traditional rigid endoscopic techniques is still crucial to optimize outcome and minimize the risk of complications in pediatric tracheobronchial foreign body removal. Chevalier Jackson's recommendation that residency training include an animal laboratory course in foreign body removal still applies.