Management of foreign bodies obstructing the airway in children.
OBJECTIVE
To review national trends in the management of pediatric airway foreign bodies (A-FBs) and esophageal foreign bodies (E-FBs) that obstruct the airway.


METHODS
Retrospective review using a national pediatric data set (Kids' Inpatient Database).


METHODS
Pediatric patients admitted across the United States during 2003.


METHODS
The Kids' Inpatient Database 2003 samples 2 984 129 pediatric discharges from 3438 hospitals in 36 states.


METHODS
The Kids' Inpatient Database 2003 was analyzed for A-FBs and E-FBs (International Classification of Diseases, Ninth Revision, Clinical Modification codes E911 and E912) in patients 20 years or younger, and weighted data are presented to facilitate national estimates.


RESULTS
A total of 2771 patients (59% male) were admitted for an A-FB or an E-FB that was obstructing the airway. The mean (SE) age of the patients was 3.5 (0.17) years; 55% were younger than 2 years. The foreign bodies were classified as food (42%; mean age, 2.5 years) or other (58%; mean age, 4.3 years). The average length of stay was 6.4 days (median [SE], 1.5 [0.6] days), and the average number of procedures was 2.4 (median [SE], 1.3 [0.1] procedures). Seventy-one percent of the patients were treated at teaching hospitals. The mean (SD) total charges were $34 652 ($3543), with regional variation (P < .001). Children's hospitals (28%) had higher mean total charges than nonchildren's hospitals (P = .03); 3.4% of admissions died in the hospital (mean [SE] age, 4.6 [0.9] years), with an average length of stay of 11.7 (SE, 2.7) days and an average of 6.2 (SE, 0.7) procedures. Bronchoscopy (52%), esophagoscopy (28%), and tracheotomy (1.7%) were the primary procedures performed. The rates of positive FB findings for bronchoscopy and esophagoscopy were 37% and 46%, respectively.


CONCLUSIONS
Pediatric A-FBs and E-FBs that obstruct the airway occur infrequently. Most of the patients are referred to teaching institutions. Among patients who were admitted with a diagnosis of airway obstruction from an A-FB or an E-FB, the rates of positive findings at surgery were 37% and 46%, respectively. A surprisingly high mortality rate was noted. Alternative education measures should be considered to train physicians in the management of this infrequent, potentially lethal condition.
Shah
Rahul K
RK
Children's National Medical Center, Washington, DC 20010, USA. rshah@cnmc.org
Patel
Anju
A
Lander
Lina
L
Choi
Sukgi S
SS
D000402:Airway Obstruction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004724:Endoscopy; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014140:Tracheotomy; D014481:United States