Clinical characteristics and factors influencing hospitalization in pediatric patients with foreign body aspiration: a comprehensive analysis in an emergency department.

Abstract

Background: Foreign body aspiration (FBA) in children is a potentially life-threatening event, especially in those under 3 years of age. This study aimed to identify clinical factors associated with hospitalization in pediatric FBA and to highlight innovative retrieval methods used in a tertiary care setting.

Methods: A retrospective analysis was conducted of pediatric patients (< 18 years) presenting with confirmed airway FBA between January 2015 and September 2023 at Srinagarind Hospital, Khon Kaen University. Demographic information, clinical characteristics, and procedural data were collected. Univariate and multivariate logistic regression analyses identified predictors of hospitalization.

Results: Among 297 pediatric patients with FBA, 39 (13.1%) required hospitalization. Hospitalized children were younger (median age: 3 years; interquartile range [IQR] 2-7) compared with non-hospitalized children (median age: 4 years; IQR 3-7, p = 0.018). FBA involving the larynx-trachea-bronchus significantly increased the likelihood of admission (adjusted odds ratio [AOR] = 22.0; 95% confidence interval [CI]: 6.64-72.63; p < 0.001). Delayed presentation to the emergency department more than two hours after onset was also associated with hospitalization (OR = 2.77; 95% CI: 1.08-7.09; p = 0.033). Although rigid bronchoscopy remained the mainstay treatment, flexible bronchoscopy was successfully utilized in nine cases. Notably, a novel technique using a 3 mm gold-plated neodymium magnet under fluoroscopic guidance enabled the safe retrieval of distal metallic foreign bodies. Complete removal of the aspirated objects was achieved in all patients; however, one patient died following prolonged hypoxia prior to hospital arrival.

Conclusions: Younger age, delayed emergency department presentation, and location of the foreign body in the larynx-trachea-bronchus are significant predictors of hospitalization in pediatric FBA. Rigid bronchoscopy remains the primary management strategy, while flexible bronchoscopy and innovative retrieval methods, including magnet-assisted approaches, offer effective alternatives in specific scenarios. Emphasizing early diagnosis and rapid intervention is essential to reduce complications and improve outcomes in children with FBA.