Tracheobronchial foreign body aspiration in children - diagnostic value of symptoms and signs

Objective: Tracheobronchial foreign body (TFB) aspiration is a common cause of respiratory compromise in early childhood. Research indicates that a high number of children are missed with TFB aspiration. The aim of this study was to identify predictors of potential TFB aspiration. Study design: We analysed 370 endoscopic reports of children admitted to our emergency department who under-went explorative rigid bronchoscopy to exclude/remove a TFB (1989-2003). Patient characteristics, history, clinical, radiographic and bronchoscopic findings were noted. Sensitivities and specificities for TFB aspiration were calculated for patient history, clinical and radiographic findings. Results: The median age was 1.8 years. In 59.7% of patients a TFB was found and removed. A group analysis was performed on children with symptoms less than 2 weeks (group A) and those more than 2 weeks (group B). The results showed that unilateral diminished breath sounds and unilateral overdistension on chest X-ray were the most sensitive (53-79%) and specific (68-88%) findings in both groups. The clinical triad of acute choking/coughing, wheezing and unilateral diminished breath sounds had a high specificity (96-98%) in both groups. In contrast, a positive history of acute choking/coughing in group A or a permanent cough in group B showed a low specificity (8-16%). Conclusion: In a paediatric respiratory compromise, the presence of unilateral diminished breath sounds, pathological chest X-ray or clinical triad is a powerful indicator for occurred TFB aspiration. Since no single or combined variables can predict TFB aspiration with full certainty, bronchoscopic exploration should be performed if TFB aspiration is suspected.