Can Clinical and Radiological Diagnosis Reduce the Need for Bronchoscopy in Pediatric Tracheobronchial Foreign Body Aspiration Cases?

Abstract

Objectives: To assess the diagnostic accuracy and efficacy of taking history, conducting physical examination, and assessing the radiological characteristics of children suspected of having aspirated foreign bodies (FBs), vis-à-vis tracheobronchoscopy, the gold standard diagnostic tool. An additional objective was to analyze the types and locations of aspirated FBs. Methods: This single-center retrospective cohort study used the archived medical data of consecutive pediatric patients who had presented with suspected tracheobronchial FB aspiration (TFBA) from January 2011 to May 2021. Data regarding clinical presentation, radiological impressions, and intraoperative findings were retrieved from electronic medical records. Results: The subjects comprised 44 children (22 male) with a mean age of 25.4 months (median = 17.5 months). The majority (27; 61.4%) had TFBA. Among the clinical symptoms, choking and coughing had a sensitivity of 93.9% and specificity of 30.0% and 50.0%, respectively in confirming the presence of a FB. Positive physical examination results had a sensitivity of 95.8% and specificity of 63.2%. Radiological results had a sensitivity of 60.0% and specificity of 78.9%. Organic substances constituted 47.7% of the aspirated FBs. Conclusions: Proper clinical assessment with history, physical examination, and imaging can highly predict the presence of TFBAs in children, and help the clinician decide whether bronchoscopy is necessary.