title: Predictors of Foreign Body Aspiration in Children.
abstract: To examine the sensitivity and specificity of history, physical examination, and radiologic studies as predictors of foreign body aspiration in children.
  
  
  
  Case series with chart review.
  
  
  
  Tertiary care children's hospital.
  
  
  
  Medical records were reviewed for 102 children who presented to our institution from 2006 to 2013 with suspected foreign body aspiration and who underwent endoscopy. Data included symptoms, physical examination, radiologic, and endoscopy findings. Descriptive statistics, sensitivity and specificity, and univariate and multivariable analyses were performed.
  
  
  
  A total of 102 patients were included (62% male). The mean age was 3.3 years (SD, 3.7). A foreign body was identified on endoscopy in 69 cases (68%). The most common presenting symptoms were cough (88%), choking/gagging (67%), and wheezing (57%). Decreased breath sounds and wheezing on examination were independently associated with increased odds of foreign body. The most common abnormal radiographic finding was air trapping (33%). The most frequent items retrieved were fragments of seeds and nuts (49%). There were no serious complications related to endoscopy. The sensitivity and specificity of any finding on history, physical examination, and imaging were 100% and 3%, 90% and 33%, 61% and 77%, respectively. Having a positive history, examination, and chest radiograph combined was 46% sensitive and 79% specific.
  
  
  
  Patients with airway foreign bodies have varied presentations. The presence of any radiologic finding suggests that endoscopy should be performed, as a foreign body is probable. The absence of any history or physical examination finding was associated with a low likelihood of a foreign body.
authors.affiliation: UPMC Medical Education Preliminary Year Residency Program, UPMC Montefiore Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Jacquelyn R
authors.initials: JR
authors.lastname: Sink
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Kitsko
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Georg
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA jeffrey.simons@chp.edu.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007223:Infant; D001239:Inhalation; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D012680:Sensitivity and Specificity
keywords: airway; aspiration; bronchoscopy; foreign body; pediatric