Citation

Reid A, Hinton-Bayre A, Vijayasekaran S, Herbert H. Int. J. Pediatr. Otorhinolaryngol. 2019; 129: e109760.

Affiliation

Perth Children's Hospital (previously Princess Margaret Hospital for Children, Perth, Western Australia, Australia.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.ijporl.2019.109760

PMID

31751807

Abstract

BACKGROUND: Whenever a paediatric airway foreign body (PAFB) is suspected, decisions may be difficult without a clearly defined or accepted treatment algorithm. History and examination are commonly non-diagnostic and the risks associated with either watchful waiting or proceeding to MLB are significant. This paper reviews a 10 year cohort of suspected PAFBs for the predictive utility of history, examination and investigations and subsequent positive findings at MLB.

OBJECTIVES: STUDY DESIGN: The medical records of 127 children who underwent MLB for suspected PAFB between 2007 and 2016 were examined. The data was retrospectively reviewed for epidemiological details, history, examination, radiological findings and MLB outcomes.

RESULTS: Sensitivity for PAFB on MLB with all three; history, examination and imaging (x-ray) positive for PAFB was 87.7%. Of the patients who were both symptom and sign positive (n = 96), chest x-ray findings did not significantly alter the chance of finding a PAFB. Chest x-ray had a low specificity (17%) in symptom and sign positive patients. Conversely, sensitivity of chest x-ray was high (88%), for symptom and sign positive patients.

CONCLUSIONS: For a child with both signs and symptoms, xray is unlikely to assist in decision making around suspected PAFB. When only sign or symptom is present, positive imaging may significantly increase the chance that PAFB is the cause.For patients with a low suspicion of PAFB, consideration of a CT can be a helpful means of excluding a PAFB and avoiding an unnecessary general anaesthetic in this potentially high-risk group.A greater level of public awareness is needed with regards to appropriate food types for children and the importance of eating seated and supervised in order to reduce the risk of PAFB.

Copyright © 2019. Published by Elsevier B.V.

Language: en

Keywords

Aspiration; Choking; Inhalation foreign body; Inhaled; Paediatric airway foreign body