Airway exploration when suspected foreign body aspiration. Is it always indicated?

• Published in: Journal of Pediatric Surgery Open 2024-10, Vol.8, p.100163, Article 100163
• Main Authors: Martinez Diaz, Maria, Ibañez Pradas, Vicente, Couselo Jerez, Miguel, Valdés Diéguez, Estíbaliz
• Format: Article
• Language: English
• Subjects: Bronchoscopy; Children; Foreign body aspiration
• ISSN: 2949-7116; 2949-7116
• DOI: 10.1016/j.yjpso.2024.100163

What is currently known about this topic?.•Bronchoscopy is the gold standard for foreign body aspiration diagnosis and treatment.•Given the low specificity of signs and symptoms, high percentage of diagnostic bronchoscopies are negative.•It is important to identify patients at low risk of foreign body aspiration, in order to avoid unjustified procedures.What new information is contained in this article?.•The type of foreign body is important in decision-making, so that nuts and seeds have a higher risk than other materials. For this reason we consider performing bronchoscopy on all patients with suspected aspiration of nuts or seeds.•In case of suspect aspiration of other materials, the algorithm proposed, including dyspnea, asymmetric auscultation, and altered chest X-ray, could identify patients at low risk of aspiration, in order to reduce negative bronchoscopy rates. Foreign body aspiration (FBA) is an important cause of morbidity and mortality in pediatrics. Flexible or rigid bronchoscopy is the gold standard for its diagnosis and treatment. However, despite being a minimally invasive test, it is not without risk and, given the low specificity of symptoms involved, between 45 and 70 % of diagnostic bronchoscopies (DB) performed are normal. The aim of this paper is to develop a strategy in order to reduce this percentage. Observational, analytical, and retrospective study of DB performed for suspected FBA between 2018 and 2022. Demographic, clinical, and radiological data, bronchoscopy findings and complications were obtained. 96 patients admitted to DB were analyzed. 72 out of 96 (75 %) were normal. The risk of presenting a foreign body was significantly higher in patients with suspected nuts, so DB should be always indicated. In patients with suspected other materials aspiration, a multivariate analysis was performed using logistic regression. Statistically significant association was found between dyspnea, asymmetric auscultation and abnormal chest radiography with the presence of a foreign body on the DB; AUC = 0.97 (95 % CI 92.4 %-100 %). The proposed algorithm establishes patients at high risk of FBA and therefore the DB is recommended, with a sensitivity of 100 % and a specificity of 87.2 %. The application of the algorithm to patients with suspected aspiration of a foreign body other than nuts can facilitate the identification of patients with high risk of aspiration and reduce the percentage of negative DB.