Predictive Accuracy of Conventional Clinico-radiological Indicators in Foreign Body Aspirations among Children: A Retrospective Study

Abstract

Introduction: Foreign Body Aspiration (FBA) is a common and serious paediatric emergency condition. A Suspected Foreign Body Aspiration (SFBA) is based on Clinical History (CH), Physical Findings (PF), and Chest Radiograph (RAD/CXR). The predictive accuracy of these factors as indicators of FBA and to perform Rigid Bronchoscopy (RB) based on these factors has been debated. Aim: To evaluate the sensitivity, specificity, positive predictive value and negative predictive value of clinical history, physical findings and radiology in SFBA. Materials and Methods: A retrospective analysis was conducted on paediatric patients with suspicion of foreign body aspiration, admitted in the Department of Paediatric Surgery at Government Medical College, Thiruvananthapuram, Kerala, India, between January 2006 and December 2020. Factors in CH, PF, and RAD were subjected to univariate and multivariate analysis to evaluate the predictive accuracy of these factors as indicators for bronchoscopy. Sensitivity, specificity, positive and NPV were calculated for the clinico-radiological indicators in predicting FBA. The association between evidence of FBA and clinico-radiological indicators was evaluated by Pearson Chi-square test; and p-values <0.05 were considered to be statistically significant. Results: A total of 458 children (263 males and 195 females) were admitted with SFBA having mean age of 29.49±24.92 months, 389 had confirmed FBA, and 69 had no FBA. The age group of 1-2 years was found to be a statistically significant factor for FBA (p-value=0.03). Foreign Body aspiration Witnessing Event (FBEW) (p-value <0.0001, sensitivity=91%, specificity=31%), choking spell (p-value <0.0001, sensitivity=95%, specificity=25%), acute cough (p-value <0.0001, sensitivity=87%, specificity=46%), tachypnea (p-value <0.0167, sensitivity=89%, specificity=20%), decreased breath sound (p-value <0.0001, sensitivity=92%, specificity=35%), abnormal CXR (p-value <0.0001, sensitivity=94%, specificity=37%) and hyperinflation (p-value <0.0001, sensitivity=95%, specificity=31%) were found to be independent statistically significant factors in FBA. Multivariate analysis showed a PPV of 97% when the aspiration event was witnessed along with abnormal physical and radiological findings. Conclusion: It was observed that assessment of clinico-radiological parameters is valuable in predicting FBA. The indications of RB in SFBA can be safely based on these clinico-radiological parameters.