Evaluation of the relevance of interhospital transfer medicalization in the suspicion of foreign body aspiration in children

Abstract

IntroductionForeign body aspiration in preschool children is a common and potentially fatal event. Diagnostic confirmation requires tracheobronchoscopy. The current medical care in West Provence Alpes Cote d'Azur (PACA) is based on an inter-hospital transfer via the emergency medical services (EMS) to the pediatric ear–nose–throat (ENT) reference center in Marseille as quickly as possible. However, the intensive care pediatric transport team has only one vehicle, which is not always available. The issue of the real risk for the suspected patient when they are asymptomatic therefore arises, questioning the presence of a physician during these transports. Main objectiveWe aimed to describe our practice regarding suspected foreign body aspiration (FBA) and assess the relevance of medical transport for children with suspected FBA regardless of their clinical and/or radiological presentation. Material and methodsThis was a retrospective, single-center study at the Timone Children's Hospital, from January 1, 2016, to December 31, 2017. Clinical and radiological data were collected from pediatric emergency files and endoscopy reports. ResultsA total of 178 children were suspected of having FBA upon arrival at the Pediatric Emergency Department of La Timone Children's Hospital; 96 children were transferred from another hospital on pediatric ENT advice. Of these 96 children, 63 were asymptomatic. Of these asymptomatic children who were transferred, 11 did not undergo tracheobronchoscopy and four children presented with a foreign body at tracheobronchoscopy (6%). When transport-related data were available, no deterioration of the clinical condition was described in these patients during transport. ConclusionIn our retrospective study of the medical care for suspected FBA in children in the West PACA region, less than 10% of children who were asymptomatic but suspected of having FBA presented with a foreign body on endoscopy, which questions the relevance of physician presence during transport of these patients.