Diagnostic evaluation of foreign body aspiration in children: a prospective study.
OBJECTIVE
The aim of this study was to evaluate the yield of clinical symptoms, signs, and radiological studies in the diagnosis of foreign body aspiration (FBA) in children.


METHODS
During the 2-year study, we performed on all children admitted to the pediatric department for suspected FBA a protocol that included the following: thorough medical history, physical examination, radiological studies (chest x-ray and fluoroscopy), and rigid bronchoscopy by a senior otolaryngologist. The yield of these measures for the diagnosis of FBA was evaluated.


RESULTS
Foreign bodies were found in 56 (57%) of the 98 children with suspected FBA. Thirty-three (59%) children were boys and 23 (41%) girls (P < .05), with a mean age of 24 months (range, 8-84 months). Main symptoms in the children with FBA were the following: choking (76.8%), prolonged cough (14.3%), dyspnea (3.6%), and nonresolving pneumonia (1.8%). Physical examination, chest x-ray, and fluoroscopy findings were abnormal in 80.4%, 67.9%, and 46.9% of the children with FBA, respectively. The diagnostic yield of physical examination and radiological studies increased 24 hours after the event of FBA. In 45.2% of the children with positive history but with normal findings from physical examination and radiological studies, foreign bodies were found. Of the children with "doubtful" history, physical examination, chest x-ray, and fluoroscopy findings were abnormal in 58%, 38%, and 12.5%, respectively. Foreign bodies were found in 9.5% of these children.


CONCLUSIONS
Medical history is the key for the diagnosis of FBA. Choking followed by an acute episode of coughing is the most common presentation of FBA. The yield of physical examination and radiological studies in the diagnosis of FBA is relatively low but is increased when the presentation is delayed and when history is doubtful. If FBA is suspected, bronchoscopy should be performed.
Even
Lea
L
Department of Pediatrics, Western Galilee Hospital, Nahariya 22100, Israel. leaeyl@naharia.health.gov.il
Lea
Even
E
Heno
Nawaf
N
Nawaf
Heno
H
Talmon
Yoav
Y
Yoav
Talmon
T
Samet
Elvin
E
Elvin
Samet
S
Zonis
Ze'ev
Z
Ze'ev
Zonis
Z
Kugelman
Amir
A
Amir
Kugelman
K
D000402:Airway Obstruction / Q000209:etiology; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D005471:Fluoroscopy; D005547:Foreign Bodies / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D013902:Radiography, Thoracic; D012189:Retrospective Studies