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Foreign Body Aspiration in Children: Analysis of Diagnostic Criteria and Accurate Time for Bronchoscopy

Ezer, Semire Serin MD*; Oguzkurt, Pelin*; Ince, Emine MD*; Temiz, Abdulkerim MD*; Çalskan, Esra MD†ı; Hicsonmez, Akgun*

doi: 10.1097/PEC.0b013e318226c896
Original Articles

Objectives: The aims of this study were to evaluate the predictive diagnostic value of history, clinical signs and symptoms, and radiological finding and to evaluate whether bronchoscopy is a safe procedure and whether it should be performed in urgent conditions.

Methods: The medical records of 191 children who underwent bronchoscopy for suspected foreign body aspiration (FBA) between 2001 and 2009 were reviewed for demographic data, radiological studies, and bronchoscopic findings retrospectively.

Results: There were 117 male and 74 female patients. Their ages ranged from 2 months to 14 years. The major complaints were paroxysmal cough and respiratory insufficiency. Foreign body aspiration was confirmed in 123 patients (65%). Of 106 patients who were admitted in the first 24 hours, FBA was confirmed in 75 patients. Of 116 patients with a definite history of witnessed FBA, 87 patients (75%) were found to have positive bronchoscopic findings. Of 46 patients who had prolonged history of recurrent pulmonary infections, allergic asthma, or bronchiolitis, 31 (67.4%) were found to have FBs. Foreign bodies were frequently organic. Nineteen patients required urgent bronchoscopic evaluation. Sensitivity and specificity for each diagnostic criterion were as follows: clinical history (63% and 32%); symptoms (68% and 53%); physical examination findings (70.5% and 63%); radiological findings (73% and 68%); and the triad of cough, wheezing, and diminished breath sound (88% and 51%), respectively. There was a positive correlation between the presence of wheezing and FB-positive patients.

Conclusions: Although there are no specific symptoms and signs to make a clear-cut diagnosis, history of witnessed FBA, admittance within 24 hours from the beginning of respiratory symptoms, and wheezing are proper indications for bronchoscopy. Bronchoscopy is a safe procedure with few and confined complications.

From the Departments of *Pediatric Surgery and †Anestesiology, Başkent University Faculty of Medicine, Ankara, Turkey.

Disclosure: The authors declare no conflict of interest.

Reprints: Semire Serin Ezer, MD, Department of Pediatric Surgery, Başkent University Faculty of Medicine, Dadaloğlu Mah 39 Sokak, No: 6, Yüreğir, Adana, 01210 Turkey (e-mail: semireserin@yahoo.com).

© 2011 Lippincott Williams & Wilkins, Inc.