Evaluation of clinical, radiologic, and laboratory prebronchoscopy findings in children with suspected foreign body aspiration

Background: Foreign body aspiration (FBA) in infants and young children is a common and potentially life-threatening event. Although studies have extensively described the signs and symptoms of suspected FBA (sFBA), only few systematically compared their value for predicting bronchoscopy results. Objectives: The objectives of this study were to describe the clinical and radiologic signs and symptoms of sFBA and to identify predictors of bronchoscopically proven FBA (pFBA). Setting: This study was conducted at a referral tertiary university hospital with an outpatient clinic and a 90-bed pediatric unit. Methods: Signs and symptoms were retrospectively analyzed for all children who had received bronchoscopy between July 1992 and April 2000 because of sFBA. Radiologic signs of FBA were reviewed and scored by 2 independent radiologists. Results: One hundred sixty children (mean age, 2.8 years; range, 11 months to 16.8 years) were enrolled in the study. Foreign body aspiration, mostly affecting the right main bronchus, was proven bronchoscopically in 122 (76%) of these children. Independent predictors of pFBA in multivariable analyses were focal hyperinflation on chest radiograph (ss = 45.4; 95% confidence interval [CI] = 5.3-390.5; P = .001), witnessed choking crisis (ss = 18.6; 95% CI = 4.7-73.0; P <.001), and white blood cell count greater than 10,000/mu L (ss = 4.2; 95% CI = 1.2-14.7; P =.026). The cumulative proportion of pFBA cases increased with the number of risk factors (0, 16%; 1, 47%; 2, 96%; 3, 100%). Conclusions: Clinical judgment to perform bronchoscopy for sFBA was correct in 76% of the children investigated. Focal hyperinflation, witnessed choking crisis, and elevated white blood cell count were strongly associated with pFBA; bronchoscopy can be strongly recommended in the presence of at least 2 risk factors when FBA is suspected. (c) 2006 Elsevier Inc. All rights reserved.