title: What is the diagnostic value of flexible bronchoscopy in the initial investigation of children with suspected foreign body aspiration?
abstract: OBJECTIVE
  The diagnosis and early bronchoscopic extraction of a foreign body (Fb) in children are life-saving measures. Many studies have described the manifestation of foreign body aspiration (FbA); however, only a few analyzed the role of flexible bronchoscopy in the diagnosis of FbA. The aim of this work is to define the indications of flexible bronchoscopy in the management algorithm of suspected FbA.
  
  
  METHODS
  This study was conducted at a tertiary referral University Medical Center with an outpatient clinic and a 20-bed pediatric emergency unit.
  
  
  METHODS
  Between January 2002 and July 2006 children referred with suspected FbA were included in this prospective study. Children with asphyxiating FbA requiring immediate rigid bronchoscopy, were excluded. If there was no convincing evidence of FbA, a diagnostic flexible bronchoscopy was performed under local anesthesia. In the case where a Fb was actually found, extraction was always performed by rigid bronchoscopy.
  
  
  RESULTS
  Seventy cases (median age: 2 years, males: 44/females: 26) were analyzed. Among the 19 children who underwent flexible bronchoscopy first, 7 (37%) had a Fb. Among the 51 who underwent rigid bronchoscopy first, 43 had a Fb and 8 (16%) had a negative first rigid bronchoscopy. Predictive signs of a bronchial Fb were a radiopaque Fb, foreign body aspiration syndrome (FbAS) associated with unilaterally decreased breath sounds or localized wheezing and obstructive emphysema or atelectasis.
  
  
  CONCLUSIONS
  In case of suspected FbA in children, the following management algorithm is suggested: rigid bronchoscopy should be performed solely in case of asphyxia, finding of a radiopaque Fb, or in the presence FbAS associated with unilaterally decreased breath sounds, localized wheezing and obstructive radiological emphysema, or atelectasis. In all other cases, flexible bronchoscopy should be performed first for diagnostic purposes.
authors.affiliation: University Hospital, ENT Department, CHU A. Michallon, Service ORL, 38043 Grenoble, France.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Righini
authors.forename: Nils
authors.initials: N
authors.lastname: Morel
authors.forename: Alexandre
authors.initials: A
authors.lastname: Karkas
authors.forename: Emile
authors.initials: E
authors.lastname: Reyt
authors.forename: Katarina
authors.initials: K
authors.lastname: Ferretti
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pin
authors.forename: Sebastien
authors.initials: S
authors.lastname: Schmerber
mesh_terms: D000465:Algorithms; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D003448:Crying; D003680:Deglutition Disorders / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007845:Laughter; D008297:Male; D008409:Mastication; D011446:Prospective Studies; D053120:Respiratory Aspiration / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors