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Indications for flexible versus rigid bronchoscopy in children with suspected foreign-body aspiration
A Martinot1, M Closset, C H Marquette
1Department of Pulmonology, Centre Hospitalier et Universitaire, Lille, France.
Insights
Flexible bronchoscopy is a safe and cost-effective diagnostic tool for suspected foreign-body (FB) aspiration in children. This approach reduces unnecessary rigid bronchoscopies, improving patient outcomes and healthcare efficiency.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Procedures
- Respiratory Medicine
Background:
- Initial diagnostic strategies for suspected foreign-body (FB) aspiration in children lack prospective evaluation.
- Current practices often involve invasive procedures without confirmed FB presence.
Purpose of the Study:
- To prospectively evaluate diagnostic indications for flexible bronchoscopy in children with suspected foreign-body aspiration.
- To develop and validate a management algorithm to optimize initial bronchoscopic investigation.
Main Methods:
- Prospective data collection of history, clinical, and radiologic findings in children with suspected FB aspiration.
- Comparison of outcomes between initial rigid bronchoscopy and flexible bronchoscopy.
- Development of a predictive model for FB presence based on clinical and radiological signs.
Main Results:
- Flexible bronchoscopy identified foreign bodies in 17 of 55 children, while initial rigid bronchoscopy found them in 23 of 28.
- Predictive signs for bronchial FB included radiopaque FB, unilaterally decreased breath sounds, and obstructive emphysema (PPV=0.94).
- The proposed algorithm would have reduced unnecessary initial rigid bronchoscopies from 21% to 4%.
Conclusions:
- Flexible bronchoscopy is a safe, cost-saving diagnostic procedure for suspected foreign-body aspiration in children.
- A new algorithm prioritizing flexible bronchoscopy in uncertain cases can significantly decrease negative initial rigid bronchoscopies.
- This strategy optimizes resource utilization and patient management in pediatric respiratory emergencies.
Abstract:
Diagnostic indications for flexible bronchoscopy in the initial investigation of children with suspected foreign-body (FB) aspiration have not been evaluated prospectively. We prospectively collected history, clinical, and radiologic findings at prebronchoscopic examination of all children referred for suspected FB aspiration between February 1993 and September 1995. Children with asphyxiating FB aspiration, requiring immediate rigid bronchoscopy, were excluded. If there was clear evidence of FB aspiration from the physical and radiographic findings, rigid bronchoscopy was directly performed. If the evidence was not convincing, children underwent diagnostic flexible bronchoscopy under local anesthesia. If an FB was found, rigid bronchoscopy was always performed for extraction. Eighty-three consecutive children (median age: 24 mo) were included. Among 28 who underwent rigid bronchoscopy first, 23 had an FB. Among the 55 children who underwent flexible bronchoscopy first, 17 had an FB. Predictive signs of a bronchial FB were a radiopaque FB, and associated unilaterally decreased breath sounds and obstructive emphysema (positive predictive value = 0.94). We propose the following management algorithm: Rigid bronchoscopy is performed first in case of asphyxia, a radiopaque FB, or association of unilaterally decreased breath sounds and obstructive emphysema. In any other case, flexible bronchoscopy is performed first for diagnostic purposes. If applied retrospectively to the 83 children in our study, this algorithm would have decreased the negative first rigid bronchoscopy rate to 4%. Flexible bronchoscopy is a safe and cost-saving diagnostic procedure in children with suspected FB aspiration.