title: A Five-Year Analysis of Airway Foreign Body Management: Toward a Better Understanding of Negative Bronchoscopies.
abstract: OBJECTIVE
  To identify characteristics in patients who undergo positive and negative bronchoscopy for a suspected airway foreign body (AFB).
  
  
  METHODS
  Review medical records between 2008 and 2012.
  
  
  RESULTS
  There were 145 patients who went to the operating room with the pre-bronchoscopy diagnosis of suspected AFB during the study period. There was an overall negative bronchoscopy rate of an average of 37%, with an annual range between 21% and 50%. The findings of history or suspicion of choking, asymmetric breath sounds, and wheezing were statistically more common in patients with an AFB. Chest roentograms (CXR) had a sensitivity and specificity of 62% and 57%. Twenty patients had a chest computed tomography (CT) scan, and 100% were clinically significant. Four CT scans were diagnostic of an AFB, and 16 patients avoided bronchoscopy after negative CT.
  
  
  CONCLUSIONS
  In current clinical practice, it is difficult to identify patients with an AFB without performing bronchoscopy. This results in a significant number of negative bronchoscopes. Certain elements in the history and physical exam were more common in patients who were found to have an AFB. Our preliminary data suggest that chest CT scans may be useful to decrease the number of negative bronchoscopies.
authors.affiliation: Baylor College of Medicine and Texas Children's Hospital, Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Houston, Texas, USA ellenf@bcm.edu.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Friedman
authors.affiliation: Laryngology Fellow, The Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Anthony
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D013902:Radiography, Thoracic; D053120:Respiratory Aspiration / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012135:Respiratory Sounds / Q000209:etiology; D012137:Respiratory System / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: airway foreign body; aspiration; chest CT scan; negative bronchoscopy; rigid bronchoscopy