Skip to main content

Advertisement

SpringerLink
Log in

Determinants of positive rigid bronchoscopy for suspected organic foreign body aspiration in children younger than five years

  • Original Article
  • Published:
Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Rigid bronchoscopy is widely used for diagnosis and treatment of foreign body aspiration (FBA) in children, but negative results can be reported, especially with radiolucent organic FBA. This study aimed to evaluate the clinical features and pre-procedure predictors of organic FBA in children under 5 years of age.

Methods

Children aged less than 5 years old who underwent rigid bronchoscopy for suspected organic FBA were retrospectively evaluated for demographics, history of aspiration, relevant clinical symptoms and signs, radiological findings, in addition to type and location of foreign body (FB). To determine the predictors of positive FBA, stepwise backward logistic regression was applied.

Results

A total of 228 children were included (69.7% boys). The mean age was 1.98 ± 1.07 years. Foreign bodies were found in 202 cases (88.59%). Age ≤ 3 years and history of witnessed choking had the highest sensitivity while diminished breath sounds had the highest specificity for diagnosing FBA. In multivariate analysis, witnessed choking, wheezy chest, diminished breath sounds, and respiratory distress were independently associated with increased risk of FBA.

Conclusion

Children under 5 years of age with suspected organic FBA have varied clinical and radiological findings. The history of choking, wheezy chest, diminished air entry, or respiratory distress increases the chance of positive rigid bronchoscopy in this age group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Available from corresponding author on request.

Abbreviations

AUC:

Area under curve

CI:

Confidence interval

FB:

Foreign body

FBA:

Foreign body aspiration

MDCT:

Multi-detector computer tomography

NPV:

Negative prediction value

OR:

Odds ratio

PPV:

Positive prediction value

ROC:

Receiver operating characteristic

VB:

Virtual bronchoscopy

References

  1. Nasir ZM, Subha ST. A Five-Year Review on Pediatric Foreign Body Aspiration. Int Arch Otorhinolaryngol. 2021;25:e193–9. https://doi.org/10.1055/s-0040-1709739.

    Article  PubMed  Google Scholar 

  2. Brkic F, Umihanic S, Altumbabic H, Ramas A, Salkic A, Umihanic S, et al. Death as a Consequence of Foreign Body Aspiration in Children. Med Arch. 2018;72:220–3. https://doi.org/10.5455/medarh.2018.72.220-223.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wu Y, Zhang X, Lin Z, Ding C, Wu Y, Chen Y, et al. Changes in the global burden of foreign body aspiration among under-5 children from 1990 to 2019. Front Pediatr. 2023;11:1235308. https://doi.org/10.3389/fped.2023.1235308.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mortellaro VE, Iqbal C, Fu R, Curtis H, Fike FB, St Peter SD. Predictors of radiolucent foreign body aspiration. J Pediatr Surg. 2013;48:1867–70. https://doi.org/10.1016/j.jpedsurg.2013.03.050.

    Article  PubMed  Google Scholar 

  5. Prowse SJ, Makura Z. Gustav Killian: beyond his dehiscence. J Laryngol Otol. 2012;126:1164–8. https://doi.org/10.1017/S0022215112001764.

    Article  CAS  PubMed  Google Scholar 

  6. Acharya K. Rigid Bronchoscopy in Airway Foreign Bodies: Value of the clinical and radiological signs. Int Arch Otorhinolaryngol. 2016;20:196–201. https://doi.org/10.1055/s-0036-1584293.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mubarak YS, Mohamed AH, Kamal YA. Rigid bronchoscopic extraction of radiolucent foreign bodies in children: outcomes of early intervention. Indian J Thorac Cardiovasc Surg. 2014;30:140–6. https://doi.org/10.1007/s12055-014-0279-8.

    Article  Google Scholar 

  8. Taşkınlar H, Bahadır GB, Erdoğan C, Yiğit D, Avlan D, Naycı A. A diagnostic dilemma for the pediatrician: radiolucent tracheobronchial foreign body. Pediatr Neonatol. 2017;58:264–9. https://doi.org/10.1016/j.pedneo.2016.07.003.

    Article  PubMed  Google Scholar 

  9. Gibbons AT, Casar Berazaluce AM, Hanke RE, McNinch NL, Person A, Mehlman T, et al. Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography. J Pediatr Surg. 2020;55:176–81. https://doi.org/10.1016/j.jpedsurg.2019.09.045.

    Article  PubMed  Google Scholar 

  10. Emir H, Tekant G, Beşik C, Eliçevik M, Senyüz OF, Büyükünal C, et al. Bronchoscopic removal of tracheobroncheal foreign bodies: value of patient history and timing. Pediatr Surg Int. 2001;17:85–7. https://doi.org/10.1007/s003830000485.

    Article  CAS  PubMed  Google Scholar 

  11. Janahi IA, Khan S, Chandra P, Al-Marri N, Saadoon A, Al-Naimi L, et al. A new clinical algorithm scoring for management of suspected foreign body aspiration in children. BMC Pulm Med. 2017;17:61. https://doi.org/10.1186/s12890-017-0406-6.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fasseeh NA, Elagamy OA, Gaafar AH, Reyad HM, Abougabal MS, Heiba DA, et al. A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a retrospective cohort study. Ital J Pediatr. 2021;47:194. https://doi.org/10.1186/s13052-021-01147-9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hitter A, Hullo E, Durand C, Righini CA. Diagnostic value of various investigations in children with suspected foreign body aspiration Review. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:248–52.

    Article  CAS  PubMed  Google Scholar 

  14. Pietras A, Markiewicz M, Mielnik-Niedzielska G. Rigid bronchoscopy in foreign body aspiration diagnosis and treatment in children. Children. 2021;8:1–7. https://doi.org/10.3390/children8121206.

    Article  Google Scholar 

  15. Behera G, Tripathy N, Maru YK, Mundra RK, Gupta Y, Lodha M. Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree. J Laryngol Otol. 2014;128:1078–83. https://doi.org/10.1017/S0022215114002837.

    Article  CAS  PubMed  Google Scholar 

  16. Cohen S, Avital A, Godfrey S, Gross M, Kerem E, Springer C. Suspected foreign body inhalation in children: What are the indications for bronchoscopy? J Pediatr. 2009;155:276–80.

    Article  PubMed  Google Scholar 

  17. Baram A, Sherzad H, Saeed S, Kakamad FH, Hamawandi AMH. Tracheobronchial Foreign Bodies in Children: The Role of Emergency Rigid Bronchoscopy. Glob Pediatr Health. 2017;4:2333794X17743663. https://doi.org/10.1177/2333794X17743663.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dorterler ME, Kocaman OH, Gunendi T, Boleken ME. A single-center experience of pediatric foreign-body aspiration: A retrospective 4-year case series. Lung India. 2019;36:202–6. https://doi.org/10.4103/lungindia.lungindia_69_18.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Reyad HM, El-Deeb ME, Abbas AM, Sherief D, Elagamy OA. Foreign body aspiration in Egyptian children clinical, radiological and bronchoscopic findings. J Multidiscip Healthc. 2021;14:2299–305. https://doi.org/10.2147/JMDH.S326967.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ding L, Su S, Chen C, Yao H, Xiao L. Tracheobronchial foreign bodies in children: experience from 1,328 patients in China. Front Pediatr. 2022;10:873182. https://doi.org/10.3389/fped.2022.873182.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Van Looij MA, Rood PP, Hoeve LJ, Borgstein JA. Aspirated foreign bodies in children: why are they more commonly found on the left? Clin Otolaryngol Allied Sci. 2003;28:364–7. https://doi.org/10.1046/j.1365-2273.2003.00725.x.

    Article  PubMed  Google Scholar 

  22. Tahir N, Ramsden WH, Stringer MD. Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children. Eur J Pediatr. 2009;168:289–95. https://doi.org/10.1007/s00431-008-0751-9.

    Article  PubMed  Google Scholar 

  23. Pan H, Lu Y, Shi L, Pan X, Li L, Wu Z. Similarities and differences in aspirated tracheobronchial foreign bodies in patients under the age of 3 years. Int J Pediatr Otorhinolaryngol. 2012;76:911–4. https://doi.org/10.1016/j.ijporl.2012.03.002.

    Article  PubMed  Google Scholar 

  24. Su S, Zhang H, Xiao L, Yao H, Ding L. Correlative factors for types of tracheobronchial foreign bodies encountered in children. Ear Nose Throat J. 2023;0:1–7. https://doi.org/10.1177/01455613231167244.

  25. Ciftci AO, Bingöl-Koloğlu M, Senocak ME, Tanyel FC, Büyükpamukçu N. Bronchoscopy for evaluation of foreign body aspiration in children. J Pediatr Surg. 2003;38:1170–6. https://doi.org/10.1016/s0022-3468(03)00263-x.

    Article  PubMed  Google Scholar 

  26. Ezer SS, Oguzkurt P, Ince E, Temiz A, Çalıskan E, Hicsonmez A. Foreign body aspiration in children: analysis of diagnostic criteria and accurate time for bronchoscopy. Pediatr Emerg Care. 2011;27:723–6. https://doi.org/10.1097/PEC.0b013e318226c896.

    Article  PubMed  Google Scholar 

  27. Paksu S, Paksu MS, Kilic M, Guner SN, Baysal K, Sancak R, et al. Foreign body aspiration in childhood: evaluation of diagnostic parameters. Pediatr Emerg Care. 2012;28:259–64. https://doi.org/10.1097/PEC.0b013e3182494eb6.

    Article  PubMed  Google Scholar 

  28. Sink JR, Kitsko DJ, Georg MW, Winger DG, Simons JP. Predictors of Foreign Body Aspiration in Children. Otolaryngol Head Neck Surg. 2016;155:501–7. https://doi.org/10.1177/0194599816644410.

    Article  PubMed  Google Scholar 

  29. Al Masaoudi L, Kolethekkat AA, Jose S, Al AR. Can Clinical and Radiological Diagnosis Reduce the Need for Bronchoscopy in Pediatric Tracheobronchial Foreign Body Aspiration Cases? Oman Med J. 2022;37:e409. https://doi.org/10.5001/omj.2022.80.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Özyüksel G, Arslan UE, Boybeyi-Türer Ö, Tanyel FC, Soyer T. New scoring system to predict foreign body aspiration in children. J Pediatr Surg. 2020;55:1663–6. https://doi.org/10.1016/j.jpedsurg.2019.12.015.

    Article  PubMed  Google Scholar 

  31. Kiyan G, Gocmen B, Tugtepe H, Karakoc F, Dagli E, Dagli TE. Foreign body aspiration in children: the value of diagnostic criteria. Int J Pediatr Otorhinolaryngol. 2009;73:963–7. https://doi.org/10.1016/j.ijporl.2009.03.021.

    Article  PubMed  Google Scholar 

  32. Tomaske M, Gerber AC, Stocker S, Weiss M. Tracheobronchial foreign body aspiration in children - diagnostic value of symptoms and signs. Swiss Med Wkly. 2006;136:533–8. https://doi.org/10.4414/smw.2006.11459.

    Article  PubMed  Google Scholar 

  33. Ayed AK, Jafar AM, Owayed A. Foreign body aspiration in children: diagnosis and treatment. Pediatr Surg Int. 2003;19:485–8. https://doi.org/10.1007/s00383-003-0965-x.

    Article  PubMed  Google Scholar 

  34. Sattar A, Ahmad I, Javed AM, Anjum S. Diagnostic accuracy of chest x-ray in tracheobronchial foreign body aspiration in paediatric patients. J Ayub Med Coll Abbottabad. 2011;23:103–5.

    PubMed  Google Scholar 

  35. Ullal A, Mundra RK, Gupta Y, Mishra S. Virtual bronchoscopy: highly sensitive time and life saving investigation in the diagnosis of foreign body aspiration-our experience. Indian J Otolaryngol Head Neck Surg. 2019;71:378–83. https://doi.org/10.1007/s12070-018-1319-2.

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Faculty of Medicine, Minia University, Al-Minya, 61519, Egypt

    Yasser Ali Kamal, Ashraf Ali Elshorbgy & Ahmed Anwar Orieby

Authors
  1. Yasser Ali Kamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashraf Ali Elshorbgy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmed Anwar Orieby
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors whose names appear on the submission 1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; 2) drafted the work or revised it critically for important intellectual content; 3) approved the version to be published; and 4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yasser Ali Kamal.

Ethics declarations

Ethics approval

Authors' Institutional Review Board (IRB) under reference number (619/2023).

Conflict of interest

The authors declare that they have no competing interests.

Patients’ consent

Not Applicable for retrospective studies.

Statement of human and animal rights

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamal, Y.A., Elshorbgy, A.A. & Orieby, A.A. Determinants of positive rigid bronchoscopy for suspected organic foreign body aspiration in children younger than five years. Indian J Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s12055-024-01744-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12055-024-01744-3

Keywords

Search

Navigation