What is the diagnostic value of flexible bronchoscopy in the initial investigation of children with suspected foreign body aspiration?
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.
Righini
Christian A
CA
University Hospital, ENT Department, CHU A. Michallon, Service ORL, 38043 Grenoble, France.
Morel
Nils
N
Karkas
Alexandre
A
Reyt
Emile
E
Ferretti
Katarina
K
Pin
Isabelle
I
Schmerber
Sebastien
S
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