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Evaluation of Foreign body aspiration score (FOBAS) in children- A retrospective cohort study

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Abstract

Foreign Body Aspiration (FBA) is a common medical emergency among young children, but the evaluation and management of a suspected FBA case can vary across physicians and centers. We aimed to identify which clinical, laboratory, and radiological findings can predict FBA in children and to evaluate a clinical score to improve FBA prediction. This is a retrospective cohort study of patients aged 0–18 years admitted to Soroka University Medical Center between 2010 and 2020 with suspected FBA. All patients underwent flexible bronchoscopy and were divided into positive and negative FBA groups. A newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, was evaluated for its predictability. The study included 412 children (median age 21 months, 56.8% females), of whom 154 (37.4%) had FBA and 258 (62.6%) did not. Multivariate regression analysis showed exposure to nuts/seeds, unilateral wheezing or decreased breath sounds, stridor, and suggestive findings on chest X-ray were significant risk factors for FBA (OR [95%CI] -1.994[1.290–3.082], 1.487[1.206–1.832], 1.883 [1.011–3.509] and 2.386[1.917–2.970], respectively). However, a choking episode, acute cough, and absence of fever and rhinorrhea did not predict FBA. FOBAS showed an increased risk of FBA for each additional point of the score, with an odds ratio of 1.572 (95% CI—1.389–1.799).

  Conclusion: FOBAS is a good predictor for the presence of FBA in children. Once prospectively validated, FOBAS could aid in decision-making at the emergency department, enabling more standardized care, reducing unnecessary procedures, and leading to better clinical outcomes.

What is Known:

• The evaluation and management of a child with suspected foreign body aspiration (FBA) vary across physicians and centers, without a consensus regarding the indications and criteria for performing bronchoscopy.

• Flexible bronchoscopy is the standard procedure for the diagnosis and sometimes treatment of FBA in children, but it may hold potential complications.

What is New:

• We propose a newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, for the prediction of FBA in children at the emergency department.

• The FOBAS is a good predictor of FBA in children. The score enables more standardized care and may reduce unnecessary procedures.

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Data availability

Raw data were generated at the Soroka University Medical Center. Derived Data supporting the findings of this study are available from the corresponding author (IGT) upon reasonable request.

References

  1. Lea E, Nawaf H, Yoav T, Elvin S, Ze’ev Z, Amir K (2005) Diagnostic evaluation of foreign body aspiration in children: a prospective study. J Pediatr Surg 40(7):1122–1127

    Article  Google Scholar 

  2. https://injuryfacts.nsc.org/all-injuries/deaths-by-demographics/sex-age-and-cause

  3. Sink JR, Kitsko DJ, Georg MW, Winger DG, Simons JP (2016) Predictors of foreign body aspiration in children. Otolaryngology-Head and Neck Surgery 155(3):501–507

    Article  PubMed  Google Scholar 

  4. Girardi G, Contador AM, Castro-Rodríguez JA (2004) Two new radiological findings to improve the diagnosis of bronchial foreign-body aspiration in children. Pediatr Pulmonol 38(3):261–264

    Article  PubMed  Google Scholar 

  5. Salih AM, Alfaki M, Alam-Elhuda DM (2016) Airway foreign bodies: A critical review for a common pediatric emergency. World J Emerg Med 7(1):5

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C (2009) Suspected foreign body inhalation in children: what are the indications for bronchoscopy? J Pediatr 155(2):276–280

    Article  PubMed  Google Scholar 

  7. Divarci E, Toker B, Dokumcu Z, Musayev A, Ozcan C, Erdener A (2017) The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration. Int J Pediatr Otorhinolaryngol 100:232–237

    Article  CAS  PubMed  Google Scholar 

  8. Anton-Pacheco JL, Martin-Alelu R, López M, Morante R, Me L, Barrero S, Luna-Paredes MC (2021) Foreign body aspiration in children: treatment timing and related complications. Int J Pediatr Otorhinola

  9. Golan-Tripto I, Mezan DW, Tsaregorodtsev S, Stiler-Timor L, Dizitzer Y, Goldbart A, Aviram M (2021) From rigid to flexible bronchoscopy: a tertiary center experience in removal of inhaled foreign bodies in children. Eur J Pediatr 180:1443–1450

    Article  PubMed  Google Scholar 

  10. Tomaske M, Gerber AC, Weiss M (2006) Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal. Pediatr Anesth 16(2):123–129

    Article  Google Scholar 

  11. Facciolongo N, Patelli M, Gasparini S, Agli LL, Salio M, Simonassi C, Zanoni P (2009) Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis 71(1):144‏

  12. Mnejja M, Chakroun A, Bougacha L, Smaoui L, Hammami B, Charfeddine I, Ghorbel A (2012) Bronchoscopy for foreign body inhalation in the pediatric population: lessons learned from 223 cases. Archives de pediatrie: organe officiel de la Societe francaise de pediatrie 19(6):670–674

    Article  CAS  PubMed  Google Scholar 

  13. Fasseeh NA, Elagamy OA, Gaafar AH, Reyad HM, Abougabal MS, Heiba DA, Kantar A (2021) A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a retrospective cohort study. Ital J Pediatr 47(1):1–9

    Article  Google Scholar 

  14. Stafler P, Nachalon Y, Stern Y, Leshno M, Mei Zahav M, Prais D, Kadmon G (2020) Validation of a computerized scoring system for foreign body aspiration: An observational study. Pediatr Pulmonol 55(3):690–696

    Article  PubMed  Google Scholar 

  15. Özyüksel G, Arslan UE, Boybeyi-Türer Ö, Tanyel FC, Soyer T (2020) New scoring system to predict foreign body aspiration in children. J Pediatr Surg 55(8):1663–1666

    Article  PubMed  Google Scholar 

  16. Janahi IA, Khan S, Chandra P, Al-Marri N, Saadoon A, Al-Naimi L et al (2017) A new clinical algorithm scoring for management of suspected foreign body aspiration in children. BMC Pulm Med 17(1):61

    Article  PubMed  PubMed Central  Google Scholar 

  17. Samuel M (2002) Pediatric appendicitis score. J Pediatr Surg 37(6):877–881

    Article  PubMed  Google Scholar 

  18. Hitter A, Hullo E, Durand C, Righini C (2011) Diagnostic value of various investigations in children with suspected foreign body aspiration. Eur Ann Otorhinolaryngol Head Neck Dis 128(5):248–252

    Article  CAS  PubMed  Google Scholar 

  19. Kadmon G, Stern Y, Bron-Harlev E, Nahum E, Battat E, Schonfeld T (2008) Computerized scoring system for the diagnosis of foreign body aspiration in children. Annals of Otology, Rhinology & Laryngology 117(11):839–843

    Article  Google Scholar 

  20. Castro MV, Limousin IT, Alonso-Allende TC, Martínez LÁ, Llinares FO (2018) Protocolo probabilístico para el manejo del cuerpo extraño en la vía aérea. Cir Pediatr 31:162–165

    Google Scholar 

  21. Lee JJ, Philteos J, Levin M, Namavarian A, Propst EJ, Wolter NE (2021) Clinical prediction models for suspected pediatric foreign body aspiration: a systematic review and meta-analysis. JAMA Otolaryngology-Head & Neck Surgery 147(9):787–796

    Article  Google Scholar 

  22. Liu B, Ding F, An Y, Li Y, Pan Z, Wang, G, Wu C (2020) Occult foreign body aspirations in pediatric patients: 20-years of experience. BMC Pul Med 20:1–6

  23. Mohsen F, Bakkar B, Melhem S, Altom R, Sawaf B, Alkhija I, Nahas LD (2021) Foreign body aspiration in a tertiary Syrian centre: A 7-year retrospective study. Heliyon 7(3):e06537

    Article  PubMed  PubMed Central  Google Scholar 

  24. Reyad HM, El-Deeb ME, Abbas AM, Sherief D, Elagamy OA (2021) Foreign body aspiration in Egyptian children clinical, radiological and bronchoscopic findings. J Multi Healthcare 2299–2305

  25. Heyer CM, Bollmeier ME, Rossler L, Nuesslein TG, Stephan V, Bauer TT, Rieger CH (2006) Evaluation of clinical, radiologic, and laboratory pre bronchoscopy findings in children with suspected foreign body aspiration. J Pediatr Surg 41(11):1882–1888

    Article  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Inbal Raviv, Shani Pozailov, Shir Avraham, Micha Aviram, Aviv Goldbart, Dvir Gatt & Inbal Golan-Tripto

  2. Department of Pediatrics, Soroka University Center Beer-Sheva, Beer-Sheva, Israel

    Shani Pozailov, Aviv Goldbart, Dvir Gatt & Inbal Golan-Tripto

  3. Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel

    Micha Aviram, Aviv Goldbart, Dvir Gatt & Inbal Golan-Tripto

  4. Department of Pediatric C, Schneider Children’s Medical Center of Israel, Petach Tikvah, Beer-Sheva, Israel

    Yotam Dizitzer

  5. Department of Anesthesiology and Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel

    Sergey Tsaregorodtsev

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  1. Inbal Raviv
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  2. Shani Pozailov
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  8. Sergey Tsaregorodtsev
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  9. Inbal Golan-Tripto
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Contributions

IGT contributed to the study's conception and design. Material preparation and data collection were performed by IR, SP, SA, MA, DG, ST, and AG. Statistical analysis was performed by YD. The first draft of the manuscript was written by IR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Inbal Golan-Tripto.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Soroka University Medical Center (0290–19-SOR.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Communicated by Peter de Winter

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Raviv, I., Pozailov, S., Avraham, S. et al. Evaluation of Foreign body aspiration score (FOBAS) in children- A retrospective cohort study. Eur J Pediatr 182, 4205–4212 (2023). https://doi.org/10.1007/s00431-023-05095-w

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  • DOI: https://doi.org/10.1007/s00431-023-05095-w

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