Elsevier

American Journal of Otolaryngology

Volume 31, Issue 5, September–October 2010, Pages 320-324
American Journal of Otolaryngology

Original contribution
Foreign body aspiration in children: the effects of delayed diagnosis

https://doi.org/10.1016/j.amjoto.2009.03.007Get rights and content

Abstract

Background

Foreign body aspiration is common in children, but there are no clinical clues that can determine or rule out the diagnosis before entering the operating room for bronchoscopy. The purposes of our study were to define the clinical characteristics of foreign body aspiration in the pediatric population and to evaluate the significance of delay in its diagnosis and treatment.

Methods and results

The study used a retrospective review of 136 charts of children up to the age of 16 who underwent bronchoscopy for foreign body removal for 10 years in Ha'Emek Medical Center (Afula, Israel). An adult witness of an aspiration episode (most frequent presenting symptom), a child younger than 2 years, and an abnormal plain chest radiography were found to be significant predictors of foreign body aspiration. Estimated risk for foreign body aspiration was significantly higher in children who were younger than 2 years with an eyewitness for the aspiration episode and abnormal chest radiography (odds ratio, 5.6, with confidence interval from 2.0 to 15.6). The rate of complication was 2-fold higher in patients who arrived at the hospital 2 days or more after the aspiration compared with patients who arrived earlier. The rate of complication was 2-fold higher in patients who underwent bronchoscopy 24 hours or more after arrival at the emergency department compared with patients who underwent bronchoscopy within the first 24 hours.

Conclusion

Delayed arrival of a child with a suspected foreign body aspiration at the hospital and delayed bronchoscopy were found to be related to a higher rate of complication.

Introduction

Foreign body aspiration is common in the pediatric population. It was estimated as a rate of 29.9/100 000 population and was responsible for the death of 160 children in the United States in 2000 [1]. In our region, the rate of bronchoscopies is 11/100 000 children per year [2]. Many foreign body aspiration events are preventable. The public health education program can help to reduce up to 35% of the incidences of foreign body aspiration but cannot eliminate it [3]. Foreign body aspiration leads to significant complications, and the rate of these complications increases with delay in diagnosis and treatment [4], [5], [6], [7], [8]. Although many comprehensive studies have dealt with the clinical presentation, diagnosis, and outcome of foreign body aspiration, there are no clearly defined clinical and radiologic characteristics that can determine the diagnosis. This uncertainty causes delay in diagnosis and treatment in clinical practice [3], [8], [9].

We reviewed our experience in the treatment of pediatric foreign body aspiration for 10 years. The aims of this retrospective study were (1) to define the clinical and radiologic features of aspirated foreign body and (2) to evaluate the consequences of delayed diagnosis and treatment of foreign body aspiration.

Section snippets

Methods

A retrospective review of all bronchoscopies performed in Ha'Emek Medical Center, Afula, Israel, between January 1994 and December 2004 was undertaken. The patients consisted of 136 children up to the age of 16 years who underwent bronchoscopy for foreign body removal. Data were collected for patient age and sex, duration of symptoms, time of diagnosis, history of aspiration events, physical examination in the emergency department (ED), and results of radiographic studies (plain chest

Epidemiology

Of the 136 patients, 86 (63.2%) children were male, and 50 (36.8%) were female. The mean age was 33 ± 34.7 months (range, 5–180 months). Most children (64%) were younger than 2 years.

A foreign body was found in 99 patients (72.8%). Positive bronchoscopies were significantly more frequent in children younger than 2 years than older children (83% and 57%, respectively; P = .001). Positive bronchoscopies were little more frequent in boys than girls (77.6% and 66%, respectively).

History and physical examination

A clear history of

Discussion

Although aspiration of a foreign body may occur at any age, in our study, it occurred mostly in children younger than 2 years, and the frequency of foreign body aspiration was higher in boys than in girls. Two thirds of the children were younger than 2 years of age, and two thirds were boys. Distribution of the patient age and sex in this study were correlated with other studies [4], [7], [10]. The rate of positive bronchoscopies (72.8%) was similar to other studies [5], [11], [12]. The high

Conclusions

In our study, 3 factors were found to be significant predictors of foreign body aspiration in children as follows: an adult witness to the aspiration episode, a child younger than 2 years, and an abnormal plain chest radiography. Negative history, normal physical examination, and normal radiography cannot rule out the aspiration of a foreign body, and a high index of suspicion is required.

The delayed arrival of a child with suspected foreign body aspiration at the hospital and delayed

References (14)

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