Cluster analysis of symptoms and assessment of caregiver reports in pediatric foreign bodies

Foreign body (FB) ingestion and aspiration are frequent causes of pediatric emergency room visits, with significant morbidity and mortality risks. This cross-sectional study analyzed 1,052 pediatric patients admitted for suspected FB events at a single institution between 2008 and 2015, including 886 cases of suspected ingestion and 166 cases of suspected aspiration. Cluster analysis identified three distinct clusters for both groups, with respiratory symptoms being predominant in clusters with worse outcomes. The respiratory clusters were associated with increased complication rates (13.0% for aspiration, 3.6% for ingestion) and all mortalities (three in aspiration and two in ingestion). In ingestion cases, Respiratory Cluster patients showed increased complications, prolonged hospital stays (mean 55.1 h), and accounted for all mortalities, a relationship not previously reported. Caregiver-reported certainty of event occurrence showed moderate sensitivity (72.5%) and low specificity (45.4%) for aspiration, and higher sensitivity (86.8%) with lower specificity (19.8%) for ingestion. Decision Curve Analysis revealed a net benefit in utilizing caregiver certainty for clinical decision-making. Confirmatory radiographic findings were commonly observed in ingestion cases (84.2%) than in aspiration cases (37.7%), likely due to the higher incidence of metal ingestions compared to mostly organic aspirations. Endoscopic management had high success rates (97.6%), and low mortality, highlighting its central role in FB treatment. These findings underscore the importance of assessing respiratory symptom severity within the broad clinical spectrum of FBs to identify patients at risk of worse clinical outcomes, which helps prioritize resources when necessary. Caregiver-reported information has been shown to be valuable in guiding diagnostic decisions.