A new clinical algorithm scoring for management of suspected foreign body aspiration in children
Abstract Background Foreign Body Aspiration (FBA) is a serious problem in children and delays in diagnosis and management can be devastating. The history is often vague, with subtle physical and chest radiograph abnormalities. This study aims to determine the indications for bronchoscopy in children...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-04-01
|
| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12890-017-0406-6 |
| _version_ | 1818192027697807360 |
|---|---|
| author | Ibrahim A. Janahi Shabina Khan Prem Chandra Noora Al-Marri Ammar Saadoon Lolwa Al-Naimi Maryam Al-Thani William Greer |
| author_facet | Ibrahim A. Janahi Shabina Khan Prem Chandra Noora Al-Marri Ammar Saadoon Lolwa Al-Naimi Maryam Al-Thani William Greer |
| author_sort | Ibrahim A. Janahi |
| collection | DOAJ |
| description | Abstract Background Foreign Body Aspiration (FBA) is a serious problem in children and delays in diagnosis and management can be devastating. The history is often vague, with subtle physical and chest radiograph abnormalities. This study aims to determine the indications for bronchoscopy in children with suspected FBA and evaluate the key clinical and statistically significant predictors of FBA, based on the patients’ historical, physical and radiological findings at presentation. Methods This is a retrospective observational study, including patients who were admitted between January 2001 to January 2011 with suspected FBA. Their presenting history, physical exam, radiological and bronchoscopic findings were analyzed. Results Three hundred children with a mean age of 2.1 ± 1.7 years were included. In children with both abnormal physical and radiological findings, 47.2% had proven FBA. If either was abnormal, the likelihood reduced to 32–33.3%; if both were normal, only 7.4% had a FB. Witnessed choking (adjusted OR 2.1, 95% CI 1.03–4.3; P = 0.041), noisy breathing/stridor/dysphonia (adjusted OR 2.7, 95% CI 1.2–6.2; P = 0.015), new onset/recurrent /persistent wheeze (adjusted OR 4.6, 95% CI 1.8–11.8; P = 0.002), abnormal radiological findings (adjusted OR 4.0, 95% CI 1.9–8.5; P < 0.001), and unilateral reduced air entry (adjusted OR 2.9, 95% CI 1.5–5.5; P = 0.001) were significant predictors of FBA (P < 0.05). When three or more risk factors were present, the cumulative proportion of children with proven FBA increased significantly. The discriminative ability of the model was found to be good; the area under the ROC curve value was 0.76 (95% CI 0.70, 0.82). The predicted cutoff score derived using ROC analysis was found to co-relate well with known clinically significant predictors of FBA. This supports our algorithm and scoring system. Conclusions A high index of suspicion is required in diagnosing airway FB. Our proposed clinical algorithm and scoring system hopes to empower physicians to accurately predict patients with a high likelihood of FBA. |
| first_indexed | 2024-12-12T00:23:59Z |
| format | Article |
| id | doaj.art-80e7cd6821dc44d48ff0564001115c02 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-12T00:23:59Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-80e7cd6821dc44d48ff0564001115c022022-12-22T00:44:39ZengBMCBMC Pulmonary Medicine1471-24662017-04-0117111010.1186/s12890-017-0406-6A new clinical algorithm scoring for management of suspected foreign body aspiration in childrenIbrahim A. Janahi0Shabina Khan1Prem Chandra2Noora Al-Marri3Ammar Saadoon4Lolwa Al-Naimi5Maryam Al-Thani6William Greer7Pediatric Pulmonology, Hamad Medical CorporationPediatrics, Hamad Medical CorporationMedical Research Center, Hamad Medical CorporationPediatrics, Hamad Medical CorporationPediatric Pulmonology, Hamad Medical CorporationPediatrics, Hamad Medical CorporationClinical Epidemiology, Sidra Medical and Research CenterClinical Epidemiology, Sidra Medical and Research CenterAbstract Background Foreign Body Aspiration (FBA) is a serious problem in children and delays in diagnosis and management can be devastating. The history is often vague, with subtle physical and chest radiograph abnormalities. This study aims to determine the indications for bronchoscopy in children with suspected FBA and evaluate the key clinical and statistically significant predictors of FBA, based on the patients’ historical, physical and radiological findings at presentation. Methods This is a retrospective observational study, including patients who were admitted between January 2001 to January 2011 with suspected FBA. Their presenting history, physical exam, radiological and bronchoscopic findings were analyzed. Results Three hundred children with a mean age of 2.1 ± 1.7 years were included. In children with both abnormal physical and radiological findings, 47.2% had proven FBA. If either was abnormal, the likelihood reduced to 32–33.3%; if both were normal, only 7.4% had a FB. Witnessed choking (adjusted OR 2.1, 95% CI 1.03–4.3; P = 0.041), noisy breathing/stridor/dysphonia (adjusted OR 2.7, 95% CI 1.2–6.2; P = 0.015), new onset/recurrent /persistent wheeze (adjusted OR 4.6, 95% CI 1.8–11.8; P = 0.002), abnormal radiological findings (adjusted OR 4.0, 95% CI 1.9–8.5; P < 0.001), and unilateral reduced air entry (adjusted OR 2.9, 95% CI 1.5–5.5; P = 0.001) were significant predictors of FBA (P < 0.05). When three or more risk factors were present, the cumulative proportion of children with proven FBA increased significantly. The discriminative ability of the model was found to be good; the area under the ROC curve value was 0.76 (95% CI 0.70, 0.82). The predicted cutoff score derived using ROC analysis was found to co-relate well with known clinically significant predictors of FBA. This supports our algorithm and scoring system. Conclusions A high index of suspicion is required in diagnosing airway FB. Our proposed clinical algorithm and scoring system hopes to empower physicians to accurately predict patients with a high likelihood of FBA.http://link.springer.com/article/10.1186/s12890-017-0406-6Foreign bodyPediatricsBronchoscopyAirway obstructionPredictors |
| spellingShingle | Ibrahim A. Janahi Shabina Khan Prem Chandra Noora Al-Marri Ammar Saadoon Lolwa Al-Naimi Maryam Al-Thani William Greer A new clinical algorithm scoring for management of suspected foreign body aspiration in children BMC Pulmonary Medicine Foreign body Pediatrics Bronchoscopy Airway obstruction Predictors |
| title | A new clinical algorithm scoring for management of suspected foreign body aspiration in children |
| title_full | A new clinical algorithm scoring for management of suspected foreign body aspiration in children |
| title_fullStr | A new clinical algorithm scoring for management of suspected foreign body aspiration in children |
| title_full_unstemmed | A new clinical algorithm scoring for management of suspected foreign body aspiration in children |
| title_short | A new clinical algorithm scoring for management of suspected foreign body aspiration in children |
| title_sort | new clinical algorithm scoring for management of suspected foreign body aspiration in children |
| topic | Foreign body Pediatrics Bronchoscopy Airway obstruction Predictors |
| url | http://link.springer.com/article/10.1186/s12890-017-0406-6 |
| work_keys_str_mv | AT ibrahimajanahi anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT shabinakhan anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT premchandra anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT nooraalmarri anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT ammarsaadoon anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT lolwaalnaimi anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT maryamalthani anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT williamgreer anewclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT ibrahimajanahi newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT shabinakhan newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT premchandra newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT nooraalmarri newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT ammarsaadoon newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT lolwaalnaimi newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT maryamalthani newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren AT williamgreer newclinicalalgorithmscoringformanagementofsuspectedforeignbodyaspirationinchildren |