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PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies

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Abstract

To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an “senior expert” group with experience of extracting more than 10 foreign bodies and a “junior/non-expert” group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed.

  Conclusion: The management of foreign body aspiration depends on the physician’s experience and the center’s habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses.

What is Known:

• Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome.

• However, consensus concerning their management is not clearly defined in the literature.

What is New:

• This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body.

• A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.

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Abbreviations

FBA:

Foreign body aspiration

FB:

Foreign body

OR:

Operating room

CRA:

Clinical and radiological assessment

SE:

Senior expert

JNE:

Junior non expert

FPLE:

Flexible pharyngolaryngeal endoscopy

ED:

Emergency department

CT:

Computed tomography

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Acknowledgements

This study was done under the aegis of the Association Française d’ORL pédiatrique (AFOP) and the Association de Pneumopédiatrie interrégionale (ASPPIR).

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Authors and Affiliations

  1. Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France

    Emilien Chebib, Charlotte Benoit, Thierry Van Den Abbeele & Natacha Teissier

Authors
  1. Emilien Chebib
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  2. Charlotte Benoit
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  3. Thierry Van Den Abbeele
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  4. Natacha Teissier
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Contributions

Dr. Chebib conceptualized and designed the study, drafted the initial manuscript, designed the data collection instruments, collected data, analyzed and interpreted data, carried out the initial analyses, and reviewed and revised the manuscript. Prof Teissier, Prof Van Den Abbeele, and Dr. Benoit conceptualized and designed the study, collected data, analyzed and interpreted data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Emilien Chebib.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Chebib, E., Benoit, C., Van Den Abbeele, T. et al. PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies. Eur J Pediatr 182, 591–600 (2023). https://doi.org/10.1007/s00431-022-04706-2

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