Delayed diagnosis of foreign body aspiration in children

Rancé, A.; Mittaine, M.; Michelet, Marine; Blondel, A. Martin; Labouret, Guilhem

doi:10.1016/j.arcped.2022.05.006

Cited by 12 publications

(11 citation statements)

References 12 publications

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“…It is also important to discuss the cases with radiolucent foreign bodies and minimal symptoms. Thoracic computer tomography (CT) has been proposed as a diagnostic tool for these cases, as well as for those with recurrent, treatment-resistant respiratory infections [ 29 ]. Due to radiation concerns, routine use of CT for the positive diagnosis of FBA is discouraged.…”

Section: Discussionmentioning

confidence: 99%

Foreign Body Aspiration in Children—Retrospective Study and Management Novelties

Mîndru,

Păduraru,

Rusu

et al. 2023

Medicina

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Foreign body aspiration (FBA) is a frequent diagnosis in children. In the absence of other lung conditions, such as asthma or chronic pulmonary infections, this manifests as a sudden onset of cough, dyspnea, and wheezing. The differential diagnosis is based on a scoring system which takes into account the clinical picture as well as the radiologic aspects. The treatment that is considered the gold-standard for FBA in children remains to be rigid fibronchoscopy, however it comes with several potentially crucial local complications such as airway edema, bleeding, and bronchospasm, along inherent issues due to general anesthesia. Material and methods: Our study is a retrospective study analyzing the medical files of the cases from our hospital over the span of 9 years. The study group consisted of 242 patients aged 0–16 years diagnosed with foreign body aspiration in the Emergency Clinical Hospital for Children “Sfânta Maria” Iași, between January 2010–January 2018. Clinical and imaging data were extracted from the patients’ observation sheets. Results: In our cohort, the distribution of children with foreign body aspiration was uneven, with the highest incidence being reported in children from rural areas (70% of cases), whereas the most affected age group was 1–3 years, amounting to 79% of all cases. The main symptoms which led to emergency admittance were coughing (33%) and dyspnea (22%). The most important factors that determined the unequal distribution were socio-economic status, which relates to a lack of adequate supervision by parents, as well as the consumption of food inappropriate for their age. Conclusions: Foreign body aspiration is a major medical emergency that may be associated with dramatic clinical manifestations. Several scoring algorithms designed to establish the need for bronchoscopy have been proposed, taking into account both the clinical and radiological results. The issue with asymptomatic or mild symptomatic cases, as well as difficulties managing cases with radiolucent foreign bodies, remains a challenge.

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Section: Discussionmentioning

confidence: 99%

Foreign Body Aspiration in Children—Retrospective Study and Management Novelties

Mîndru,

Păduraru,

Rusu

et al. 2023

Medicina

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“…El retraso diagnóstico o terapéutico puede explicarse por causas asociadas al médico, recursos, padres o historia clínica poco informativa (20) . Respecto a la historia clínica, el cuadro puede presentarse, incluso sin el antecedente de ahogo o asfixia en población pediátrica (27) . Por este motivo, nuestros resultados resaltan la importancia del manejo oportuno y correcta evaluación de los pacientes dentro de las primeras 48 horas.…”

Section: Discussionunclassified

“…The diagnostic or therapeutic delay can be explained by causes associated with the physician, resources, parents or uninformative medical records 20 . Regarding the medical records, the condition may occur even without a history of choking or asphyxia in the pediatric population 27 . For this reason, our results highlight the importance of timely management and correct evaluation of patients within the first 48 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Patient evolution after discharge from HEP was not evaluated due to the nature of the study design. Although we only evaluated the data from the medical records, post-extraction complications are infrequent 18 , 21 , 27 , 28 and if they had occurred, the patient would have opted to return. Since the data were collected manually by means of a data collection form, information bias may have occurred.…”

Section: Discussionmentioning

confidence: 99%

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Asociación entre el tiempo de enfermedad previo a broncoscopia y tiempo de alta posbroncoscopia en pacientes pediátricos con aspiración de cuerpo extraño: estudio de cohorte retrospectivo en un centro de referencia peruano, 2014-2019.

Huarhua Jimenez,

Kruchinsky Lozada,

Galdos Bejar

et al. 2023

Rev Peru Med Exp Salud Publica

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Objective. To determine the association between pre-bronchoscopy time of illness and post-bronchoscopydischarge time in pediatric patients with foreign body aspiration. Materials and methods. Retrospective cohort study. Medical records were studied and reviewed at the Pediatric Emergency Hospital of Lima, Peru. We reviewed 324 medical records, and selected 183 because they had the diagnosis of foreign body aspiration and complete data. Fisher’s exact test and Mann Whitney U test were used for the bivariate analysis, while Poisson regression was used to calculate the Relative Risk (RR) and its 95% confidence interval (CI). Results. We included 183 patients, of whom 65.6% were men with a mean age of 2.4 years. The most frequent location of the foreign body was the right bronchial tree and most of them were made of organic material. The majority (72.7%) of patients were discharged before 24 hours. We found an association between the time of illness prior to bronchoscopy and post-bronchoscopy discharge time (RR: 2.94, 95%CI: 1.72 – 5.01). Conclusions. The time of illness prior to bronchoscopy and the length of hospital stay after removal of the foreign body were significantlyassociated when adjusted for age, sex, type of foreign body and mouth sweep maneuver as a rescue measure. Our findings are relevant because they highlight the importance of early care, timely diagnosis and early management of pediatric patients.

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“…If an FBA has not been detected directly, children can later develop nonspecific symptoms like chronic cough or recurrent pneumonias. Delayed diagnosis occurs in some patients [17 ▪ ]. Therefore, FBA must always be considered by the treating physician in case of chronic respiratory complaints.…”

Section: Diagnosis Can Be Challengingmentioning

confidence: 99%

Foreign body aspiration in children – being safe and flexible

Keil

Schwerk

2023

Current Opinion in Anaesthesiology

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Purpose of reviewAnesthesia for foreign body removal in children can be quite challenging. Even though rigid bronchoscopy is considered the gold standard for foreign body removal, there is increasing evidence for successful foreign body removal using flexible bronchoscopy. This review discusses the recent implications for flexible bronchoscopy for the purpose of foreign body removal and will compare these findings to rigid bronchoscopy.Recent findingsDuring the last few years, several observational studies on foreign body removal by flexible bronchoscopy have been published, with promising results.SummaryFlexible bronchoscopy is a feasible and safe method for removing aspirated foreign bodies in children. In order to improve patient safety during the procedure, it is necessary for a pediatric anesthetist and a pediatric pulmonologist to work closely together. The anesthetist can take care of the administration of the anesthetic and maintenance of the vital functions, and the pulmonologist can carry out a safe and fast bronchoscopy. In the case of foreign body removal by flexible bronchoscopy, the anesthesiological procedure of choice should be general anesthesia with controlled ventilation via a laryngeal mask.

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Delayed diagnosis of foreign body aspiration in children

Cited by 12 publications

References 12 publications

Foreign Body Aspiration in Children—Retrospective Study and Management Novelties

Foreign Body Aspiration in Children—Retrospective Study and Management Novelties

Asociación entre el tiempo de enfermedad previo a broncoscopia y tiempo de alta posbroncoscopia en pacientes pediátricos con aspiración de cuerpo extraño: estudio de cohorte retrospectivo en un centro de referencia peruano, 2014-2019.

Foreign body aspiration in children – being safe and flexible

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