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Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?
1Pediatric Surgery Department, Pediatric Hospital La Fe, Avenida de Campanar, 21, E-46009 Valencia, Spain
Insights
A history of choking is the most reliable indicator for pediatric bronchial foreign body (FB) aspiration, even with normal imaging. Bronchoscopy is recommended for all suspected choking incidents to avoid delayed diagnosis and serious complications.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Bronchial foreign body (FB) aspiration is a frequent pediatric emergency.
- Delayed diagnosis of FB aspiration can lead to severe complications, including fatality.
- Reliable diagnostic indicators for bronchoscopy are needed.
Purpose of the Study:
- To identify the most sensitive and specific clinical and radiologic findings for pediatric bronchial foreign body aspiration.
- To determine the necessity of bronchoscopy in cases of suspected FB aspiration.
Main Methods:
- Retrospective study of 100 pediatric patients undergoing rigid bronchoscopy for FB aspiration.
- Comparison of clinical history, symptoms, and radiologic findings with bronchoscopy results.
Main Results:
- A history of choking crisis demonstrated high sensitivity (97%) and good specificity (63%).
- Other symptoms and radiologic findings had high sensitivity but low specificity.
- Normal radiologic findings and minimal symptoms did not exclude FB aspiration.
Conclusions:
- A history of choking crisis is a strong predictor for bronchial foreign body aspiration in children.
- Bronchoscopy should be considered in all children with a choking history, irrespective of imaging results or symptom severity.
- Early bronchoscopic intervention is crucial for managing pediatric FB aspiration.
Abstract:
The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.