Prediction and diagnosis of suspected foreign body aspiration in children using flexible bronchoscopy: a retrospective cohort study

Abstract

A thorough clinical history of witnessed or suspected choking and a high index of suspicion are critical for reducing and managing early and late complications of foreign body aspiration (FBA). Flexible fiberoptic bronchoscopy (FFB) is increasingly used for diagnostic and therapeutic purposes. This study aimed to identify risk factors and predictors of FBA in children undergoing FFB. A total of 141 children (median age, 24 months; 60% male) who underwent FFB were included and categorized into FBA-positive (35.4%) and FBA-negative (64.6%) groups. The Foreign Body Aspiration Score (FOBAS) was used as a predictive tool. Multivariate logistic regression analysis was conducted to identify significant risk factors. Significant predictors of FBA included a history of choking, unilateral or decreased breath sounds, exposure to nuts or seeds, unresolved or recurrent consolidation, atelectasis, and aeration asymmetry on chest radiographs (OR = 1.992, p = 0.002; OR = 1.456, p < 0.001; OR = 0.234, p = 0.003; OR = 2.497, p < 0.001; OR = 0.789, p = 0.042; OR = 1.268, p = 0.015; OR = 1.268, p < 0.001, respectively). The total FOBAS was significantly higher in the FBA group (OR = 2.756, p < 0.001), and FOBAS risk group classification significantly distinguished between FBA-positive and FBA-negative patients (OR = 2.078, p < 0.001). In patients within the FOBAS low-risk group, recurrent or unresolved pneumonia/atelectasis was a predictive factor for diagnosing FBA. Eighteen cases (36%) had foreign bodies removed using FFB alone, while 13 cases (26%) underwent combined FFB and rigid bronchoscopy (RB) during the same procedure. The combined approach is suitable for clinically stable patients, can reduce the need for two separate anesthesia procedures, and may help avoid unnecessary interventions.

Conclusion: FOBAS is a useful tool for predicting FBA and may help reduce unnecessary procedures in suspected cases. Clinical experience of a pediatric pulmonologist in FOBAS low-risk group patients can guide the diagnosis of FBA through FFB. Performing evaluation and removal during the same FFB session is feasible in stable patients and may improve clinical outcomes.

What is known: • A detailed clinicalAQ history of a witnessed or suspected choking episode, along with a high index of suspicion, is critical for reducing and managing both early and late complications of FBA. • RB is currently the gold standard for removal, while FFB is increasingly used for both diagnostic and therapeutic purposes. • Each center follows its own criteria for performing FFB or RB in children with suspected FBA. The FOBAS is a recently introduced and the only prospectively validated scoring system for use in pediatric emergency settings.

What is new: • The FOBAS score can aid in diagnosing FBA in pediatric pulmonology outpatient clinic settings. Wider implementation of FOBAS in pediatric pulmonology practice may reduce unnecessary interventions. • Higher FOBAS scores were significantly associated with confirmed FBA. In patients within the FOBAS low-risk group, recurrent or unresolved pneumonia/atelectasis was a predictive factor for diagnosing FBA. • FFB can safely confirm or rule out FBA and guide removal strategies in collaboration with RB when necessary. A multidisciplinary approach to the management of pediatric FBA is essential.

Keywords: Children; Flexible bronchoscopy; Foreign body aspiration; Rigid bronchoscopy; Score.