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

Background

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.

Methods

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.

Results

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 %.

Conclusions

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.