Determinants of positive rigid bronchoscopy for suspected organic foreign body aspiration in children younger than five years

Rigid bronchoscopy is widely used for diagnosis and treatment of foreign body aspiration (FBA) in children, but negative results can be reported, especially with radiolucent organic FBA. This study aimed to evaluate the clinical features and pre-procedure predictors of organic FBA in children under 5 years of age.

Children aged less than 5 years old who underwent rigid bronchoscopy for suspected organic FBA were retrospectively evaluated for demographics, history of aspiration, relevant clinical symptoms and signs, radiological findings, in addition to type and location of foreign body (FB). To determine the predictors of positive FBA, stepwise backward logistic regression was applied.

A total of 228 children were included (69.7% boys). The mean age was 1.98 ± 1.07 years. Foreign bodies were found in 202 cases (88.59%). Age ≤ 3 years and history of witnessed choking had the highest sensitivity while diminished breath sounds had the highest specificity for diagnosing FBA. In multivariate analysis, witnessed choking, wheezy chest, diminished breath sounds, and respiratory distress were independently associated with increased risk of FBA.

Children under 5 years of age with suspected organic FBA have varied clinical and radiological findings. The history of choking, wheezy chest, diminished air entry, or respiratory distress increases the chance of positive rigid bronchoscopy in this age group.