Safely Decreasing Rigid Bronchoscopies for Foreign-Body Aspiration in Children: An Algorithm for the Emergency Department

Haller, Layla; Barazzone-Argiroffo, Constance; Vidal, Isabelle; Corbelli, Regula; Mehrak, Anooshiravani-Dumont; Mornand, Anne

doi:10.1055/s-0037-1603523

Cited by 19 publications

(74 citation statements)

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“…Flexible and rigid bronchoscopy has been employed for the diagnosis and treatment of aspirated foreign material in human medicine. [26][27][28][29][30][31][32][33][34] This is in contrast to veterinary medicine, for which flexible fiberoptic bronchoscopy has been employed almost exclusively in dogs and cats. [18][19][20][21][22][23] Rates of success for tracheobronchial foreign material retrieval range from 86% to 97% in dogs.…”

Section: Discussionmentioning

confidence: 99%

Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration

et al. 2019

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Objective To evaluate the diagnostic and therapeutic utility of bronchoscopy in dogs undergoing computed tomography (CT) and surgery for intrathoracic disease (pyothorax and pneumothorax) secondary to migrating plant awns (MPA) and to report outcomes in dogs that did and did not undergo bronchoscopy in addition to CT and surgery. Study design Retrospective case series. Animals Thirty‐seven client‐owned dogs. Methods Medical records from 2008 to 2017 were reviewed for dogs with documented MPA in the thoracic cavity treated with CT and surgery with or without bronchoscopy. Information regarding diagnostics, treatments, complications, and outcomes relating to hospitalization was evaluated. Results At least one abnormal lung lobe was identified by CT in all dogs. Bronchial abnormalities were identified with bronchoscopy in 21 of 22 dogs (95.4%) with available reports. Agreement between CT and bronchoscopy findings ranged from 50% to 81.8%, depending on lung lobe. Thirty‐six dogs had one or more lung lobes surgically removed. Thirty‐seven MPA were retrieved via bronchoscopy in 10 of 27 (37%) dogs, and 39 MPA were retrieved at surgery in 26 of 37 (70.3%) dogs. Actinomyces spp. were cultured from surgical samples in 7 of 33 (21.2%) dogs. Thirty‐five of 37 (94.6%) dogs survived to discharge. Conclusion Migrating plant awns were successfully retrieved via bronchoscopy. Agreement between CT findings and bronchoscopy was inconsistent, so there may be roles for both modalities. Short‐ and long‐term survival was excellent in this cohort. Clinical significance Bronchoscopy may allow for diagnostic and therapeutic advantages compared with CT in dogs with endobronchial MPA. Actinomyces spp appear to be variably present in surgically acquired bacterial cultures in dogs with MPA.

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Section: Discussionmentioning

confidence: 99%

Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration

et al. 2019

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“…In some centers, this latter concern, combined with the low‐risk perception of the procedure, has led to a protocol that demands a flexible bronchoscopy in each and every child with any degree of FBA suspicion. This approach was adopted by Cohen et al, who studied 142 children consecutively referred to the ER for suspected FBA . All automatically underwent bronchoscopy, with a 43% detection rate.…”

Section: Discussionmentioning

confidence: 99%

“…Haller et al also proposed a diagnostic algorithm for pediatric FBA. Comparing their 23 patients with foreign body to 47 without, symptoms and clinical signs that were statistically significantly different between the groups were cyanosis, sudden choking, apnea, and unilaterally decreased breath sounds.…”

Section: Discussionmentioning

confidence: 99%

“…Several diagnostic algorithms have been suggested, to help clinicians with the conundrum of when to perform diagnostic bronchoscopy in suspected FBA . While it is a noble goal to avoid unnecessary bronchoscopies, false‐negative scores might sway the doubting clinician to withhold a bronchoscopy and thus miss a foreign body.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, neither of these findings is sufficiently sensitive or specific in their own right to reliably predict the presence of a foreign body in the airways. [7][8][9][10][11] Several algorithms have been proposed to aid the diagnosis of FBA in children, [11][12][13][14] combining varying constellations of parameters from history, physical examination, and radiographic findings. To the best of our knowledge, none of them have been validated in a further cohort of children with suspected FBA.…”

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Validation of a computerized scoring system for foreign body aspiration: An observational study

Stafler

Nachalon

Stern

et al. 2020

Pediatric Pulmonology

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Objective The diagnosis of foreign body aspiration (FBA) is challenging. In a previous study, we developed a computerized scoring system (CSS) to support decision‐making. In the present study, we aimed to validate it on a further cohort. Study Design In this observational study, 100 children referred to the emergency department of a tertiary pediatric hospital for suspected FBA and treated according to standard protocol, were assigned a probability score using the CSS, between 0 and 1 (0, very low probability; 1, very high). The diagnosis of FBA was based on bronchoscopy, and if discharged without bronchoscopy, determined via telephone questionnaire, 4 to 6 months after discharge, supplemented by clinical re‐evaluation and bronchoscopy, if respiratory symptoms persisted. Results Thirty‐five out of 100 children (35%) underwent bronchoscopy with 12 of 35 (34%) positive for FBA. Sixty‐five patients were discharged without bronchoscopy and completed a telephone questionnaire. Seven patients required clinical re‐evaluation for persistent respiratory symptoms, in two out of them, additional bronchoscopies were performed and were negative. The CSS median probability score was 0.94 in patients with FBA, as compared to 0.73 in patients without FBA (P = .007). The CSS area under the receiver operating curve was 0.74. At a probability score threshold of 0.6, the sensitivity and specificity were 100% and 41%, respectively. Conclusion The present validation study suggests a high sensitivity of the CSS for the identification of FBA in children. We suggest that it might aid decision‐making with regard to the need for bronchoscopy in children presenting to the emergency room.

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Clinical Prediction Models for Suspected Pediatric Foreign Body Aspiration

Lee

Philteos

Levin

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEAlthough various clinical prediction models (CPMs) have been described for diagnosing pediatric foreign body aspiration (FBA), to our knowledge, there is still no consensus regarding indications for bronchoscopy, the criterion standard for identifying airway foreign bodies.OBJECTIVE To evaluate currently available CPMs for diagnosing FBA in children.DATA SOURCES Performed in Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL database with citation searching of retrieved studies.STUDY SELECTION Prediction model derivation and validation studies for diagnosing FBA in children were included. Exclusion criteria included adult studies; studies that included variables that were not available in routine clinical practice and outcomes for FBA were not separate or extractable.DATA EXTRACTION AND SYNTHESIS We followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies and the Prediction Model Risk of Bias Assessment Tool framework. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was the diagnosis of FBA as confirmed by bronchoscopy. Characteristics of CPMs and individual predictors were evaluated. The final model presentation with available measures of performance was provided by narrative synthesis. A meta-analysis of individual predictor variables and prediction models was performed.RESULTS After screening 4233 articles, 7 studies (0.2%; 1577 patients) were included in the final analysis. There were 6 model derivation studies and 1 validation study. Air trapping (odds ratio [OR], 8.3; 95% CI, 4.4-15.5), unilateral reduced air entry (OR, 4.8; 95% CI, 3.5-6.5), witnessed choking (OR, 3.1; 95% CI, 1.0-9.6), wheezing (OR, 2.5; 95% CI, 1.2-5.2), and suspicious findings suggestive of FBA on radiography (OR, 18.5; 95% CI, 5.0-67.7) were the most commonly used predictor variables. Model performance varied, with discrimination scores (C statistic) ranging from 0.74 to 0.88. The pooled weighted C statistic score of all models was 0.86 (95% CI, 0.80-0.92). All studies were deemed to be at high risk of bias, with overfitting of models and lack of validation as the most pertinent concerns.CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis suggests that existing CPMs for FBA in children are at a high risk of bias and have not been adequately validated. No current models can be recommended to guide clinical decision-making. Future CPM studies that adhere to recognized standards for development and validation are required.

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Safely Decreasing Rigid Bronchoscopies for Foreign-Body Aspiration in Children: An Algorithm for the Emergency Department

Cited by 19 publications

References 20 publications

Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration

Utility of bronchoscopy combined with surgery in the treatment and outcomes of dogs with intrathoracic disease secondary to plant awn migration

Validation of a computerized scoring system for foreign body aspiration: An observational study

Clinical Prediction Models for Suspected Pediatric Foreign Body Aspiration

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