Foreign Body Aspiration In Children Research Articles

Bronchial foreign body presenting as pneumothorax and pneumomediastinum in a young child.

Pneumomediastinum (PM) and subcutaneous emphysema (SCE) following foreign body aspiration are very rare. Pneumomediastinum (PM) occurs due to alveolar rupture, whereas subcutaneous emphysema occurs if air leak persists. It is benign in nature, but in some cases, it might be fatal. Therefore, proper assessment and management are required to limit the life-threatening complications and FB should always be suspected whenever spontaneous PM and SCE is seen. PM and SCE are very rare presentations of foreign body aspiration in children of age less than 3 years and in such circumstances, the possibility of foreign body should be considered. There is also a rare possibility of spontaneous expectoration of a foreign body dislodged in the trachea.

Predictive value of clinico-radiological variables in the management of suspected foreign body aspiration in children: A ten-year retrospective cohort study

ABSTRACT Background: Definite history is not always present in children with foreign body aspiration (FBA), hence necessitating a high index of suspicion. Objective: To assess the predictive value of clinico-radiological variables among children presenting with features of suspected FBA and to document their course in a tertiary care teaching hospital. Materials and Methods: In this retrospective observational study, we included children aged below 15 years presenting with clinical features of suspected FBA. Data was obtained from case records. Multivariable binary logistic regression analysis (MVA) was performed to determine statistically significant predictors of FBA, and Weighted Risk Scores (WRS) were calculated to determine the significance of the model. Results: Of the 296 children included in the study and having undergone bronchoscopy, 84.5% were toddlers; 269 (90.87%) had a foreign body (FB) removed. Organic material was commonly found with 64.3% being peanut and right main bronchus, the commonest lodging site (50.6%). Of the 54 (18%) children with symptomatic but unwitnessed FBA, 45 (83.3%) had a FB retrieved. Choking with sudden onset cough, stridor, unilateral decreased breath sounds, abnormal chest radiograph, unilateral hyperinflation and mediastinal shift correlated with FBA (P < 0.05). MVA confirmed statistical significance with choking with sudden onset cough to predict FBA (P = 0.024) with overall sensitivity and specificity of 60.9% and 77.8%, respectively. Total WRS with cut-off >2 showed good power of discrimination with sensitivity, specificity and AUC of 60.2%, 77.8% and 0.704%, respectively. Conclusions: The proposed predictive value-based scoring system enhances accuracy in decision-making regarding bronchoscopy in children with suspected FBA.

Knowledge and Awareness of the First Aid Management of Foreign Body Aspiration in Children Among the General Population: A Cross-Sectional Study in Saudi Arabia.

This study aims to assess the level of awareness and knowledge regarding the first aid management of foreign body aspiration (FBA) in children among various demographic groups. A cross-sectional survey was conducted, involving 500 participants. The survey included questions about demographic information and knowledge of FBA management. The data were analyzed to identify significant differences in awareness levels based on gender, age, nationality, educational background, occupational status, and marital status. The study found significant differences in awareness levels across various demographic groups. Females (80.2%) demonstrated higher awareness compared to males (71.5%), with a significant p-value of 0.035. Participants aged 30-39 years had the highest awareness (83.6%), though the difference was not statistically significant (p=0.057). Nationality did not significantly affect awareness levels. However, educational background showed variations, with postgraduate degree holders having somewhat lower awareness (65.9%) compared to bachelor's degree holders (78.1%), though this difference was not significant (p=0.271). Occupational status had a significant impact, with military personnel displaying the highest awareness (100%) and business professionals the lowest (67.7%), with a significant p-value of 0.009. Marital status also influenced awareness, with married individuals showing higher awareness (82.8%) compared to single (74.4%) and divorced (65.5%) individuals, with a significant p-value of 0.040. The study highlights the need for targeted educational programs to enhance first aid knowledge across different demographic groups. By addressing gaps in awareness through comprehensive training, especially among groups with lower awareness levels, we can improve the general population's ability to manage FBA incidents effectively, thereby reducing associated morbidity and mortality in children.

Foreign body aspiration in children: A review of prevention guidelines by analyzing choking episodes in Eastern Québec from 2006 to 2020

BACKGROUND Many associations have published prevention guidelines to advise parents and health professionals about the risks of choking episodes and their complications. Yet, every year, many children are admitted following a choking episode that requires a bronchoscopy under general anesthesia. OBJECTIVES The objective was to identify the risks factors associated with choking episodes in children and compare them with actual prevention guidelines to determine if they are still adequate. METHODS This retrospective study included all patients, from 0 to 17 years old, who presented to the Center Mère-Enfant Soleil du CHU de Québec - Université Laval, between April 2006 and December 2020 and underwent a bronchoscopy under general anesthesia for a suspicion of foreign body aspiration. Data on demographic characteristics of the patients, the circumstances of the episodes and on severity criteria were collected and compared to the prevention guidelines. RESULTS Of the 101 patients included, 64.9% of them were boys with a mean age at presentation of 31.5 months. Food was the most common type of foreign body (73.3%) involving mostly nuts, seeds or raw vegetables. Choking episodes happened mostly at home (84.5%) and the majority (79.4%) happened under parental surveillance. A general increase in the number of admissions for choking episodes was noted. CONCLUSION Choking episodes requiring hospital admission were on the rise mostly due to a lack of adherence or knowledge of national prevention guidelines. These findings highlight the need for better parental education by addressing choking hazards during medical visits.

Foreign body aspiration in children: Challenges, insights, and pathways forward

Foreign body aspiration in children: Challenges, insights, and pathways forward

A real-world study of foreign body aspiration in children with 4227 cases in Western China

The early diagnosis and treatment of foreign body aspiration (FBA) can significantly improve the overall prognosis of children. There are significant differences in the epidemiology and clinical characteristics of FBA in different regions. Therefore, we conducted a real-world study in the western region of China with over 4000 patients. The aim of this study was to improve the understanding of FBA in terms of its types, the specific months of its occurrence, and the distribution of primary caregiver characteristics in western China. We collected the clinical and epidemiological data of children who were diagnosed with FBA in our hospital over the past 20 years through a big data centre. We matched the data of healthy children who underwent routine physical examinations at the paediatric health clinic during the same period to analyse the differences in the data of actual guardians. A total of 4227 patients from five provinces were included in this study. Foreign bodies were removed by rigid bronchoscopy in 99.4% (4202/4227) of patients, with a median age of 19 months and a median surgical duration 16 min. January was the most common month of onset for 1725 patients, followed by February, with 1027 patients. The most common types of foreign objects were melon peanuts, seeds and walnuts, accounting for 47.2%, 15.3%, and 10.2%, respectively. In the FBA group, the proportion of grandparents who were primary caregivers was 70.33% (2973/4227), which was significantly greater than the 63.05% in the healthy group (2665/4227) (P < 0.01). FBA most commonly occurs in January and February. More than 60% of FBAs occur between the ages of 1 and 2 years, and the incidence of FBA may be greater in children who are cared for by grandparents. A rigid bronchoscope can be used to remove most aspirated foreign bodies in a median of 16 min.

Flexible bronchoscopy for foreign body aspiration in children: A single-centre experience.

The technological evolution of bronchoscopy has led to the widespread adoption of flexible techniques and their use for both diagnostic and therapeutic purposes. Currently, there is an active debate regarding the comparative efficacy and safety of rigid vs flexible bronchoscopy in the treatment of foreign body aspiration. To evaluate our experience with tracheobronchial foreign body extraction using flexible bronchoscopy and provide a literature overview. This was a single-centre retrospective study. Twenty-four patients were enrolled between January 2017 and January 2023. Medical records of patients aged below 18 years who were admitted to authors' affiliated institution with a suspected diagnosis of foreign body aspiration were collected from hospital's database to Microsoft Excel 2019. Data were analysed using MedCalc Statistical Software. Patient ages varied from 9 months to 11 years. The median age was 23.5 months, 95% confidence interval (CI) 19.49-44.77. We observed age clustering in children with foreign body aspiration at our institution with three age subgroups: (1) 0-25 months; (2) 40-60 months; and (3) 120-140 months. We expectancy of an organic tracheobronchial foreign body was significantly higher in 0-25 months subgroup than that in older ones when subgroups 40-60 and 120-140 months were combined together (odds ratio = 10.0, 95%CI: 1.44-29.26, P = 0.0197). Successful foreign body extraction was performed in all cases. Conversion to a rigid bronchoscope was not required in any of the cases. No major complications (massive bleeding, tracheobronchial tree perforation, or asphyxia) were observed. Flexible bronchoscopy is an effective and safe method for tracheobronchial foreign body extraction in children.

Foreign body aspiration in children: our pediatric tertiary care experience.

Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5days (± 2.9). Complications such as pneumothorax were seen in two cases. Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff.

Retrospective Indicators of Foreign Body Aspiration in Children of the Surgery Department of the Osh Interregional Children's Clinical Hospital

The article provides the results of a retrospective analysis of medical documentation (medical history form No. 003/Y) in 245 children with foreign bodies of the respiratory tract who were hospitalized at the Osh Interregional Clinical Children’s Hospital from 2012 to 2016. According to localization, foreign bodies in the respiratory tract were mostly in 56 (22.85%) patients — in the right main bronchus, 32 (13.1%) children — in the left main bronchus.

Tracheobronchial foreign body aspiration in children in Soweto, South Africa: A retrospective descriptive study.

Airway foreign bodies are a common cause of accidental death in children. Tracheobronchial foreign body aspiration (FBA) can result in severe immediate and long-term complications if the foreign body is not identified and removed. Little is known about the burden of tracheobronchial FBA in the Soweto area, south of Johannesburg, South Africa. Objectives. To describe the burden and clinical characteristics of tracheobronchial FBA in hospitalised children in a tertiary-level hospital in Johannesburg. This was a retrospective, single-centre, descriptive study of children aged <10 years who presented to Chris Hani Baragwanath Academic Hospital from 1 January 2011 to 31 December 2020. Children with FBA were identified from the paediatric pulmonology and paediatric surgery databases using the relevant International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), codes (T17.4 and T17.5). Clinical and radiological data were extracted from medical records and the databases. Forty-seven children with FBA were identified during the study period. Overall, the incidence of FBA among children aged <10 years of age was 1.42 per 100 000 person-years (95.0% confidence interval 1.04 - 1.88). FBA occurred more commonly in males (66.0%; n=31), and the mean (standard deviation) age at presentation was 68 (28.2) months. Most of the children (42.6%) were in the 7 - <10-year age group, followed by the 5 - <7-year age group (27.7%). Chronic respiratory symptoms were reported in one-third of the children, and a history of witnessed FBA was reported in only 59.6% of cases. Inorganic foreign bodies (n=29; 61.7%) were aspirated more commonly than organic foreign bodies; these included metal objects such as pins or springs (21.3%), toy parts (17.0%), pen or pencil lids/stoppers (12.8%) and plastic objects (6.4%). Our study highlights the fact that tracheobronchial FBA is prevalent in school-aged children, and public safety campaigns targeted at this age group are warranted. Furthermore, to prevent sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy. What the study adds. Our study demonstrated that tracheobronchial foreign body aspiration (FBA) was most prevalent in school-aged children (7 - <10 years of age), which is in contrast to studies that have reported a high prevalence in children aged <3 years. Chronic respiratory symptoms were reported in only a third of the children, and a history of witnessed FBA was reported in only 59.6%. Chest radiographs were normal in a high proportion of cases in which a chest radiograph was done (56.3%). Inorganic foreign bodies were aspirated more commonly than organic foreign bodies.Implications of the findings. Public safety campaigns should be targeted at school-aged children in Soweto, South Africa. Clinicians should investigate children with respiratory symptoms suggestive of FBA, even if a history is not forthcoming. Furthermore, to prevent long-term respiratory sequelae, a high index of suspicion in required in children with respiratory symptoms that fail to respond to appropriate therapy.

Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children.

FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA,therefore,awell-defined algorithm is needed to improve the decision-making process. • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.

Foreign Body Aspiration in Children: Retrospective Case Series and Literature Update

Background: Foreign body aspiration is common among older infants and toddlers and is an important cause of morbidity and mortality. It may escape notice by the physicians due to lack of knowledge of the exact history, high variability of clinical presentation, variable latency of the onset of symptoms, and inconclusive radiographical findings. Case report: We present a case series about children diagnosed with foreign body aspiration referred to the Pediatric Respiratory Unit of San Marco Hospital in Catania between January 2018 and November 2022. Data regarding demographic characteristics, symptoms, and type of foreign body were collected and analyzed. Conclusion: Early diagnosis is the key to therapeutic success and effective management of foreign body aspiration. We will review the literature to highlight the diagnostic difficulties related to this condition and the useful tools to recognize and manage it. The most essential part of foreign body aspiration treatment is prevention and the need to educate parents and primary care physicians. It is, therefore, of the utmost importance to consider airway foreign bodies as a cause of cough unresponsive to therapy, recurrent wheezing, and relapsing pneumonia.

Comparison of rigid bronchoscopy and flexible bronchoscopy for the management of foreign body aspiration in children

ObjectiveTo compare clinical outcomes of flexible and rigid bronchoscopies for the management of foreign body aspiration (FBA) in different airway locations, especially in unilateral main bronchus, in children, so as to provide some suggestions to assist clinical decisions. MethodsThe medical records of children diagnosed with FBA in Qingdao Women and Children's Hospital Affiliated to Qingdao University from January 2020 to June 2022 were retrospectively reviewed. The following information was collected: demographics, radiological findings, endoscopic findings, foreign body locations, duration of operation, operation cost, and intraoperative and postoperative complications. Results182 children were included in the study with the median age of 1.3 years (interquatile range, 1.0–1.8). Among whom, 124 cases (68.1 %) were male and 58 cases (31.9 %) were female. 11 cases (6.0 %) had the foreign bodies located in the trachea (larynx to carina), 3 cases (1.6 %) located in the trachea and lower bronchus, 1 case (0.5 %) located in bilateral main bronchus, 135 cases (74.2 %) located in unilateral main bronchus, 4 cases (2.2 %) located in main and lobar bronchus, and 28 cases (15.4 %) located in the lobar or segmental bronchus. Among all the included children, 84 cases (46.2 %) received rigid bronchoscopy (RB) and 98 cases (53.8 %) received flexible bronchoscopy (FB). 131 cases with the foreign bodies located in unilateral main bronchus received one type of bronchoscopy (RB or FB). They were divided into two groups according to the location of foreign body relative to the midpoint of main bronchus, the proximal bronchus group and the distal bronchus group. In the proximal bronchus group, duration of operation using RB and FB was 15 (12.5–27.5) min and 15 (14.5–30.0) min, respectively (Z = 0.000, P = 1.000). The intraoperative and postoperative complication rate using RB and FB was 15.4 % and 9.1 %, respectively (χ2 = 0.008, P = 0.927). Operation cost of FB was significantly higher than that of RB (t = −13.396, P = 0.000). In the distal bronchus group, duration of operation using RB was 20 (13.5–25.0) min, which was drastically shorter than that of FB (25 (20.0–35.0) min) (Z = −2.947, P=0.003). Operation cost of FB was still found to be significantly higher than RB (t = −20.456, P=0.000). No significant difference was found in complication rate of RB (14.3%) compared to FB (8.3%) (χ2=0.251, P=0.616). ConclusionsWhen foreign bodies are lodged in unilateral main bronchus, RB could be chosen as the first-choice procedure with advantages in duration of operation and operation cost, especially for patients in China. Regardless of duration of operation and operation cost, FB is also a safe and efficient therapeutic procedure to remove inhaled foreign bodies in children, except for those located in the trachea and asphyxiating foreign bodies.

Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature.

Foreign Body Aspiration (FBA) represents a leading cause of death among unintentional injuries in children less than one year of age. This study reviewed case reports and case series reporting non-food FBA in children to characterize aspirated foreign bodies, describing the clinical presentations and the outcomes. A systematic review was conducted according to the PRISMA checklist. Case reports and case series presenting non-food FBA in children (up to 18 years) were eligible to be included. Information regarding study characteristics, child demographics, foreign body characteristics, clinical presentation, and outcome were extracted. The review included 248 articles published between 1965 and 2023, corresponding to 294 cases. The male gender was the most prevalent (194 cases, 66%), and the median age was 3.5 years (Interquartile Range: 1-8 years). Button batteries were the objects most frequently reported (21 cases, 7.1%). Objects were located most often in the bronchus (102 cases, 35%). The most common symptom was cough (181 cases, 62%), followed by respiratory distress (160 cases, 54%) and wheezing/stridor (127 cases, 43%). The present systematic review may have relevant public health implications, since characterizing objects that cause foreign body injuries is essential to reduce the burden of this phenomenon.

Foreign body aspiration in children at University of Gondar Comprehensive Specialized Hospital, a two year retrospective study

IntroductionForeign body aspiration (FBA) is defined as asphyxia, suffocation, or inhalation of items of food, such as bone and seed, and non-food, such as toys, into the respiratory tract. Aspiration of foreign bodies is an important and preventable cause of mortality and morbidity in children, especially those less than 3 years of age. The aim of this study was to analyse the clinical and radiological profile, modes of management, and outcomes of foreign body aspiration in children at the University of Gondar Comprehensive Specialized Hospital and identify areas of possible interventions for proper management of such cases. MethodA retrospective review of the medical records of all patients suspected of foreign body aspiration at the University of Gondar Comprehensive Specialized Hospital (UoGCSH) from January 1, 2021, to January 1, 2023, G.C. was conducted. Clinico-radiological features, types and locations of foreign bodies, modes of management, and patient outcomes were studied. ResultsA total of 73 patients suspected of having a possible foreign body aspiration were identified. The median age of the patients was 24 months, with an IQR of 14 and 39, with 46 (75.3 %) being under 3 years of age. 45 (61.6 %) were male, while 28 (38.4 %) were female, making the M:F ratio 1.6:1. A foreign body aspiration history could be obtained in 68 (93.1 %) of the patients, while in 4 (5.9 %) of the cases, patients or their families were not aware of any kind of aspiration. Among the children presented, 65 (89 %) had a choking episode, coughing 66 (91 %), vomiting 63 (86.3 %), tachypnea 61 (83.6 %), and stridor 15 (20.5 %). The most common physical finding observed was nasal flaring along with subcostal and intercostal retraction in 59 (80.8 %), followed by decreased air entry in 40 (54.8 %), wheeze in 37 (50.7 %), and absent air entry in the affected side in 4 (5.5 %) of the patients. A chest x-ray was done on all patients. 28 (41.2 %) had normal chest x-rays. With regard to procedure-related complications, 3 (4.1 %) patients had cardiac arrest, 1 (1.36 %) had pneumothorax, and 1 patient died. ConclusionAny bronchopulmonary infection with an unusual course should be suspected of being the result of the aspiration of a foreign body. Increased public and professional awareness of the importance of early bronchoscopy in all suspected cases of foreign body aspiration is necessary. In order to lower the incidence, those providing care must be taught routine preventive measures.

Management of Foreign Body Aspiration in Children: Insights From 664 Cases in the Operating Room

Tracheal or bronchial foreign body aspiration is an important emergency o childhood requiring bronchoscopy under general anesthesia. In this retrospective study, bronchoscopy were performed for foreign body aspiration; anesthesia methods, risks, and postoperative complications were evaluated. Children who underwent bronchoscopy with suspicion of a foreign body in the pediatric surgery operating room between January 2010 and December 2021 were included in the study. Six hundred and sixty four children were evaluated. General anesthesia was applied to all bronchoscopy. Demographic characteristics of the patients, type of foreign body, localization of foreign body, distribution of foreign body according to age groups, complications related to anesthesia and surgical process, length of stay in the postoperative intensive care unit, and duration of hospital stay were evaluated. The patients who aspirated foreign bodies most frequently were children aged 1-3 years (73.6%). During bronchoscopy, organic matter (seeds, hazelnuts, peanuts, chickpeas) was the most frequently removed foreign body in children (559 patients). It was observed that foreign bodies were mostly located in the right main bronchus at a rate of 52.4%, the left main bronchus at 28%. The most common anesthesia-related complications were desaturation in 400 patients, hypercarbia in 200 patients, bronchospasm in 108 patients, and respiratory arrest in 2 patients. Many problems may be encountered in foreign body inhalation, and bronchoscopy of these patients should be performed by an experienced anesthesiologist and surgeon at the right time and in the safest way in terms of anesthesia and surgery.

96 Foreign Body Aspiration in Children: A Review of the Public Health Prevention Guidelines by Analyzing the Circumstances of Choking Episodes in a Canadian Tertiary Centre from 2006 to 2020

Abstract Background Choking and foreign body aspiration are major causes of morbidity and mortality in infants and young children. To prevent choking episodes and their complications, many associations, from the Canadian Paediatric Society to National Public Health Institutes, have suggested prevention guidelines for parents and health professionals. They specify what types of food should be restricted in young children, such as nuts and raw hard vegetables, and give advice on surveillance. Yet, every year, children are admitted to our centre following a choking episode that requires a bronchoscopy under general anesthesia. Objectives Our objective was to identify the risks factors associated with choking episodes in children and compare them with actual prevention guidelines to determine if public health recommendations are still adequate. Design/Methods This retrospective study included all patients, from 0 to 17 years old, who presented to our tertiary centre between April 2006 and December 2020 and underwent a bronchoscopy under general anesthesia for a suspicion of foreign body aspiration. Data on demographic characteristics of the patients, the circumstances of the episodes and on severity criteria were collected from the patients’ electronic files and compared to the prevention guidelines. Results One-hundred and ninety-one patients with a history of suspected foreign body aspiration were included. Among them, 101 had a positive bronchoscopy. Close to 65% of patients were boys. The mean age at presentation was 31,5 months. Food was the most common type of foreign body, causing 73,3% of all choking episodes. Close to 70% of those choking episodes involved nuts, seeds or raw hard vegetables. 84,5% of those events happened at home, and 79,4% of choking episodes happened under the surveillance of one or both parents. Thirty patients ended in the paediatric intensive care unit where they spent an average of 6,47 days. Conclusion Our results show that most choking episodes in children result from a non-respect of actual recommendations. They involve types of food and circumstances that are already restricted by the prevention guidelines. It highlights the need for better parent education and should inspire clinicians to make some time to address choking hazards with families.

Investigation of foreign body aspiration knowledge and first-aid self-efficacy of child development department students

ABSTRACT The study was carried out to determine the knowledge of child development students about foreign body aspiration in children, their first aid self-efficacy for foreign body aspiration, and to examine the relationship between their knowledge levels and first aid self-efficacy. The study was of descriptive and cross-sectional type. 118 students were included in the study. Descriptive Characteristics Form, Knowledge Evaluation Form about Foreign Body Aspiration in Children, and First Aid Self-Efficacy in Children with Foreign Body Aspiration Form were used to collect the study data. Foreign body aspiration knowledge scores of students were determined as 10.94 ± 2.29. The first aid self-efficacy score of students was low. A positive and significant relationship was found between students’ knowledge scores and self-efficacy scores (p < 0.05). Although the level of knowledge of students about foreign body aspiration in children is above average, their first aid self-efficacy was found to be low.

Evaluation of Foreign body aspiration score (FOBAS) in children- A retrospective cohort study.

Foreign Body Aspiration (FBA) is a common medical emergency among young children, but the evaluation and management of a suspected FBA case can vary across physicians and centers. We aimedto identify which clinical, laboratory, and radiological findings can predict FBA in children and to evaluate a clinical score to improve FBA prediction. This isa retrospective cohort study of patients aged 0-18years admitted to Soroka University Medical Center between 2010 and 2020 with suspected FBA. All patients underwent flexible bronchoscopy and were divided into positive and negative FBA groups. A newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, was evaluated for its predictability. The study included 412 children (median age 21months, 56.8% females), of whom 154 (37.4%) had FBA and 258 (62.6%) did not. Multivariate regression analysis showed exposure to nuts/seeds, unilateral wheezing or decreased breath sounds, stridor, and suggestive findings on chest X-ray were significant risk factors for FBA (OR [95%CI] -1.994[1.290-3.082], 1.487[1.206-1.832], 1.883 [1.011-3.509] and 2.386[1.917-2.970], respectively). However, a choking episode, acute cough, and absence of fever and rhinorrhea did not predict FBA. FOBAS showed an increased risk of FBA for each additional point of the score, with an odds ratio of 1.572 (95% CI-1.389-1.799). Conclusion: FOBAS is a good predictor for the presence of FBA in children. Once prospectively validated, FOBAS could aid in decision-making at the emergency department, enabling more standardized care, reducing unnecessary procedures, and leading to better clinical outcomes. What is Known: •The evaluation and management of a child with suspected foreign body aspiration (FBA) vary acrossphysicians and centers, without a consensus regarding the indications and criteria for performing bronchoscopy. • Flexible bronchoscopy is the standard procedure for the diagnosis and sometimes treatment of FBA inchildren, but it may hold potential complications. What is New: • We propose a newly developed foreign body aspiration score (FOBAS), based on medical history, physical examination, and chest X-ray findings, for the prediction of FBA in children at the emergency department. • The FOBAS is a good predictor of FBA in children. The score enables more standardized care and may reduce unnecessary procedures.

Foreign Body Aspiration in Children-Retrospective Study and Management Novelties.

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.