Aspirated foreign bodies in children: 10-Years experience in a single tertiary centre in New Zealand

OBJECTIVE: Aspirated foreign bodies (FB) are potentially life-threatening conditions which can be challenging to diagnose in children. The previous similar study from our hospital, published in 2014, created a guideline suggesting when to proceed to laryngobronchoscopy (LB) in suspected FB aspiration with over 99 % sensitivity. The grading system included the presence or absence of acute history, positive examination, and/or radiological findings, including witnessed choking, dysphonia, stridor, wheezing, or reduced air entry on examination or abnormal radiological findings. The current study reviewed a further 10 years and 5 months of data to re-evaluate the ongoing diagnostic usefulness of the three positive findings in children with suspicion of aspirated FB.

METHODS: We undertook a retrospective review of all LB performed at our institution for suspected acute FB aspiration from August 2013 to January 2023. We analysed patient characteristics, clinical examination, radiological findings, and outcomes.

RESULTS: We found a total of 100 children under the age of 16 years who underwent LB for suspected FB aspiration. The mean age of our study population was 2.6 years. The population demographics were similar to the results from the previous study from our institution, with Māori and Pasifika children having the highest probability of finding a FB on LB. Male children presenting for suspected FB aspiration are 1.39 times more likely than female children to have a foreign body at LB (p = 0.04). Overall, having two or more positive findings had a sensitivity of 100 %. History or examination alone are more sensitive (both 95.6 %) but less specific (12.5 % and 31.3 %, respectively). Abnormal radiology alone was more specific (75.0) but less sensitive (77.9 %). The most common site of FB was the right bronchial tree (45.6 %), followed by the left (39.7 %). 95 % of FB were organic, and 54 % were nuts. The negative bronchoscopy rate was 32 %.

CONCLUSION: Two or more positive indicators in history, examination and radiological findings continue to be highly sensitive predictors for the presence of an aspirated foreign body in our paediatric population. We recommend a future large-scale multicentre study to confirm how applicable these findings would be to a broader cohort of patients.