Clinical characteristics in suspected tracheobronchial foreign body aspiration in children

The objective of this study was to assess clinical characteristics of suspected tracheobronchial foreign body (TFB) aspiration in children to determine whether any singular feature of the history, physical examination, or radiologic evaluation would predict actual TFB aspiration. Chart review of all bronchoscopies was performed for the clinical suspicion of TFB aspiration in children younger than 16 years of age. Data extracted included history (witnessed event, choking history), clinical symptoms, results of physical examination, and radiographic evaluation. A total of 94 children (62 boys and 32 girls; mean age, 46.5 ± 45.9 months) were evaluated for suspected TFB aspiration. Bronchoscopy identified TFB in 39 children (TFB group). Bronchoscopy did not identify TFB in 55 children (non-TFB group). Overall, 57 children (61%) had a witnessed aspiration. In the TFB group, 33 of 39 children (85%) had a witnessed event whereas in the non-TFB group 24 of 55 children (44%) were witnessed (odds ratio for TFB for a witnessed event was 7.1 [95% confidence interval, 2.7-21.3; p < 0.0001]). Of the 94 children, choking was observed in 53%. In the TFB group, 79% of children had a choking event whereas choking was observed in only 35% of children in the non-TFB group (odds ratio for TFB for choking was 7.3 [95% confidence interval, 2.9-20.1; p < 0.0001]). Other clinical symptoms such as dyspnea and cough were not helpful in differentiating the presence or absence of a TFB. No specific finding on physical examination was helpful at predicting the presence of a TFB. Radiographic findings were also unhelpful unless a radiopaque TFB was visualized. In children with suspected TFB aspiration, each of the two clinical features - a choking episode and witnessed aspiration - is seven times more likely in those with bronchoscopically identified TFB compared with those without TFB. Other clinical features and chest radiographs are less helpful in predicting the presence of TFB. Nevertheless, some negative bronchoscopies are necessary to exclude TFB in children with suspected TFB aspiration.