DIAGNOSIS OF FOREIGNBODY ASPIRATION IN CHILDREN BY AHMED Y. AL-AMMAR, MD,FKSU.

DIAGNOSIS OF FOREIGNBODY ASPIRATION IN CHILDREN

BY

AHMED Y. AL-AMMAR, MD,FKSU

FBA

Annual incidence of death (500-2000) in USA

Age 1-3 years

Organic material are the most common

FBS

Hx. Of FBA may be – clear 50% - less obvious 50%

(challenging)

20-24% FBA are misdiagnosed

FBA

Reliable indicators: - chocking

– sudden onset coughing – unilateral wheeze

- unilateral reduction of A/E – radiological finding of emphysema,

atelectasis, FB

FBAOBJECTIVE

To assess the diagnostic value of – symptoms

– signs – radiological

findings

FBA materials and methods

Retrospective study of 39 children – bronchoscopy ( presumptive DX of FBA) KAUH

Jan 1991 to Dec 2000

Based on bronchoscopy: - group A; (30 children) +ve

FBA – group B; (9 children) –ve FBA

FBAmaterials and methods

cont.

Assessment of symptoms, signs, and radiological findings in each group

Findings were compared in the two groups

FBAresults

Male 25 female 14

Mean age 28.5 mon.

Time of presentation; A; mostly within 24 h.

B; between 2 d. And 18 mon.

FBAresult/ discussion

Matching symptoms, signs and radiological finding does not lead to the DX most of time F.Oguz et al : found all the reliable indicators in only 23%Only 17% of our patientsDX of FBA based on only one indicator is associated with other difficulties

Presenting symptom Group APercentage of affected children

Group BPercentage of affected children

Choking7733Coughing8780Breathing difficulty4333Noisy breathing3033Cyanosis3310vomiting4710

Table 1: shows the frequency of presenting symptoms

FBAR/D

Coughing – high sensitivity

87% in our study – specificity 22%

FBAR/D

Choking - sensitivity of 77%

- specificity of 67% - both in agreement with

Metrangolo

HX; coughing and choking – sensitivity of 67%

- specificity of 78%

FBS R/D

Unilateral reduction of AE: - sensitivity 43%

- specificity 78% (most specific)

In 25%; no matching between reduction of AE and bronchoscopy findings

FBSR/D

Wheezing; sensitivity of 63%

specificity of 67%

Exam (reduction of AE and wheezing) - sensitivity 17% - specificity 100% (far from reported specificity of the combined signs and symptoms 11.7)

FBAchest radiograph

Especially insp. & exp films

Lateral dequbitus

Fluoroscopy

Last two for uncooperative children

X-ray findingGroup AGroup BNormal 12 (40%)1 (11%)Emphysema*8 (27%)3 (33%)Atelectasis* 3 (10%)0Demonstration of FB*5 (17%)0X-ray not done2 (7% )0Patchy infiltrate 03 (33%)

Table 2; demonstrates findings on chest X-ray

*Match the location of FB by bronchoscopy

FBAchest radiograph

Was done within few hours to 10 days

Group A; abnormal 57%, normal 40%

Group B; abnormal 89%

Normal C-X-ray can be seen; - bronchial FBs; 7-32% - laryngotracheal FBs; 60-80%

Should not preclude bronchoscopy

FBAchest radiograph

Sensitivity; 57% (reported 70%)

Specificity; 50% (reported 45-62%)

FBAchest radiograph

Air-trapping – early – 65% (37% in our study)

Atelectasis – more slowly – 25% (11% in our study)

Radioopaque FBs – 5% (18% in our study)

– laryngeal FBS were more easy to demonstrate - could be due to the size

Category Sensitivity Specificity

History 67%78%

Physical exam. 17%100%

Chest radiograph57%50%

Table 3; compare the diagnostic value of the different categories

FBAR/D

Very important to take advantage of all diagnostic indicators

Above all implement a high index of suspicion

FBAR/D

To come with more reliable results and conclusions;

- larger number of children – prospective study

– clear protocol