Evaluation of emergency department admissions due to foreign body aspiration in children

Purpose: This study aimed to retrospectively evaluate the demographic and clinical characteristics, laboratory and imaging results, treatments, and outcomes of pediatric patients who presented to the emergency department with suspected foreign body aspiration or related complaints, based on their medical records. Secondly, it was planned to discuss the potentially significant predictive criteria for the need for bronchoscopy by examining the characteristics (age, sex, clinical findings, laboratory tests, imaging results) of the groups that underwent bronchoscopy versus those who did not. Method: Between June 2019 and 2024, pediatric patients who presented to the emergency department of the Akdeniz University Faculty of Medicine Hospital with the ICD-10 diagnosis code T17 and its subcategories (foreign body in the respiratory tract) were screened. A data collection form was created to gather the patient's file number, age, sex, date of presentation (month and year), day of presentation, complaints, duration until presentation, type and method of presentation, location of the incident, who brought the patient, medical and family history, emergency triage code, vital signs (temperature, respiratory rate, heart rate, consciousness level (AVPU), SpO2), whether there was pathology, respiratory and other pathological physical examination findings, whether respiratory treatment was needed, pathological laboratory findings, pathological imaging findings, clinical decisions, whether bronchoscopy was performed, whether a foreign body was detected, and if detected, the location in the respiratory system, any complications that developed, whether antibiotic treatment was administered, and the patient's outcome information. The collected data were statistically analyzed in accordance with the objectives of the study. Results: A total of 775 presentations that met the criteria during the study period were reviewed. Of these patients, 47% were male and 53% were female. A significant portion of the presentations (%28) were made by patients under one year of age, which contrasts with the literature. A total of 125 patients underwent bronchoscopy, of which 81 patients (%64.8) had a foreign body detected, while 44 patients (%35.2) did not. Among the patients in whom a foreign body was detected by bronchoscopy, 64.2% were under one year of age, and 18.5% were between one and two years old, which again contrasts with the literature. When evaluated by year and month, the positive bronchoscopy rate was higher in 2022 (%29.6), while the negative rate was higher in 2023 (%36.4). In May and June, the negative rate was higher (%15.9 each), with lower positive rates (%4.9 and %2.5). No findings were identified that could affect the bronchoscopy results before, during, or after the COVID-19 pandemic. The type of presentation, method, and content of the complaint, as well as whether the complaint was singular or multiple, did not show a relationship with the bronchoscopy result. None of the patients with psychomotor retardation had a foreign body detected on bronchoscopy. There was no observed relationship between vital signs, the presence or absence of pathology, and bronchoscopy results. Pathological findings in respiratory physical examination and radiological imaging were more commonly seen in patients with foreign bodies detected by bronchoscopy, and these two findings were statistically significant(p = 0.001 and p < 0.001). In positive cases, the most common findings during the examination were decreased breath sounds and unequal breath sounds bilaterally. No statistically significant relationship was found between the laboratory parameters examined and bronchoscopy results. Consistent with the literature, foreign bodies were most frequently detected in the right main bronchus (%62.5) and left main bronchus (%26.2). Of the 125 bronchoscopies performed, only 3 complications occurred. It was found that the duration between presentation and diagnosis was significantly longer for patients who received antibiotic treatment compared to those who did not. 90.3% of the patients who underwent bronchoscopy were admitted to the service, while the remaining patients were admitted to the intensive care unit for follow-up. Additionally, during the study period, bronchoscopy revealed foreign bodies in the respiratory tract of four out of nine patients who were suspected of foreign body aspiration in the pediatric pulmonology clinic. Conclusion: In our study, it was suggested that the presence of pathological physical examination findings in the respiratory system and pathological radiological imaging findings increased the likelihood of detecting a foreign body in the patient's airways and could serve as predictive factors for performing bronchoscopy. No effect of the other parameters in the data form on predicting foreign body aspiration was identified. Due to the identification of only two parameters that could predict the need for bronchoscopy, it was not possible to create a scoring table in our study. Furthermore, the complication rate after bronchoscopy was 2.4%, indicating that it is a safe procedure. In conclusion, bronchoscopy performed with the suspicion of foreign body aspiration is an invasive procedure that requires anesthesia and should only be performed when necessary. We believe that larger patient populations and multi-center evaluations could provide more meaningful data for developing predictive recommendations and a scoring system for this issue. Key words: Foreign body aspiration, Foreign body, Broncoscopy, Radiological findings, Physical examination