Pediatric Sharp Foreign Body Aspiration: Revealing Unexpected Risk Factors.

Objective: Characterize the demographic and clinical features of pediatric sharp foreign body aspiration (FBA).

Study design: Twenty-four-year retrospective chart review.

Setting: Four tertiary-care centers across four Canadian provinces.

Methods: A retrospective chart review was conducted on pediatric patients who underwent rigid bronchoscopy for sharp FBA below the vocal cords at the McGill University, McMaster University, University of Alberta, and Dalhousie health centers from January 1, 2000, to November 30, 2023.

Results: In total, 48 patients (27 males and 21 females, mean age of 10.1 years) met the inclusion criteria. Thumbtacks were the most common aspirated objects (66.7%). The mean age for thumbtack aspiration was 11.6 years, which was significantly higher than the 7.0-year mean for other sharp FBAs (P = .0263). Subgroup analysis of patients who resided in an Indigenous territory had a significantly greater rate of thumbtack aspiration (89.3%, P = .0001). Sharp FBA presented with typical symptoms of FBA with the addition of a higher incidence of chest pain (27.1%) and hemoptysis (18.8%), and it was characterized by a higher incidence of radiopaque FBs on chest radiography (89.6%). Most complications, including postoperative atelectasis (27.1%), pneumothorax (4.2%), perforation (2.1%), and vocal cord hematoma (2.1%), were observed with thumbtacks.

Conclusion: This is the largest pediatric study on sharp FBA in America, addressing a significant gap in the literature. Considering the trends and patient demographics identified in this study and in the literature globally, geographical or cultural variations may influence the nature of sharp FBA in pediatric populations. Insights from this study can inform future prevention programs.