Related Experiment Videos
Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?
J E Barrios Fontoba1, C Gutierrez, J Lluna
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. Early diagnosis via bronchoscopy is crucial for preventing 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, life-threatening outcomes.
- Current diagnostic methods often lack sufficient accuracy, necessitating improved indicators for timely intervention.
Purpose of the Study:
- To identify reliable clinical and radiologic findings for indicating bronchoscopy in pediatric FB aspiration.
- To compare the diagnostic value of various symptoms and imaging against confirmed bronchoscopy findings.
Main Methods:
- Retrospective study of 100 pediatric patients undergoing rigid bronchoscopy for suspected FB aspiration.
- Analysis of clinical history, presenting symptoms, and radiologic findings.
- Comparison of these data with direct bronchoscopy results to determine diagnostic sensitivity and specificity.
Main Results:
- A history of choking crisis demonstrated the highest sensitivity (97%) and good specificity (63%) for FB aspiration.
- Other symptoms and radiologic findings, while sensitive (88% and 85%), had low specificity (9%).
Conclusions:
- Bronchoscopy is recommended for all pediatric patients with a history of choking, irrespective of symptoms or radiologic findings.
- A choking crisis history is a critical predictor for pediatric bronchial foreign body aspiration, guiding the need for bronchoscopy.
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.