Department of Otolaryngology, University Of Nigeria Teaching Hospital Enugu, Enugu, Nigeria.
Clin Otolaryngol. 2010 Dec;35(6):479-85. doi: 10.1111/j.1749-4486.2010.02214.x.
To evaluate the yield of clinical and radiological features in the diagnosis of suspected foreign body aspiration in children and to assess factors associated with delayed diagnosis of foreign body aspiration.
Retrospective review of 10 years of experience in tertiary referral centre.
Data were extracted from clinical records of children who underwent rigid bronchoscopy for suspected foreign body aspiration at the University of Nigeria Teaching Hospital Enugu from 2000 to 2009.
Clinical features and radiological findings were validated against bronchoscopic findings.
Data of 103 children, (mean=2.7 years, range=months to 14 years; 64% boys and 36% girls, were analysed. Majority (73%) were under 3 years of age. Foreign body aspiration was proven bronchoscopically in 85 (83%) patients. The most common symptoms were sudden choking crisis (74%) and paroxysms of cough (73%). Independent predictors of proven foreign body aspiration were witnessed aspiration, choking crisis and unilateral decreased breath sounds in univariate (P=0.001, <0.001, and 0.001 respectively) and multivariable analyses (P=0.02, 0.001, and <0.001 respectively). The most sensitive and specific clinical features were choking (86%) and witnessed aspiration episode (89%), respectively. Available chest radiographs revealed radio-opaque objects in 27% of patients. Delayed diagnosis of foreign body aspiration (>72 h) was significantly more in younger children (t=3.29; P=0.001), as well as in children with no history of witnessed aspiration, negative chest examination and radiological signs (P<0.001, P=0.02 and P=0.04 respectively).
To prevent the delayed diagnosis, witnessed aspiration, choking crisis, unilateral decreased breath sounds and radiopaque objects should be checked in all suspected cases. When history is doubtful, regardless of radiological findings, bronchoscopy can be strongly recommended in the presence of two factors.
评估临床和影像学特征在疑似儿童异物吸入诊断中的表现，并评估与异物吸入延迟诊断相关的因素。
对 10 年来在三级转诊中心进行的硬质支气管镜检查疑似异物吸入的儿童临床资料进行回顾性分析。
从 2000 年至 2009 年，在尼日利亚大学教学医院恩古尼对接受硬质支气管镜检查疑似异物吸入的儿童的临床记录中提取数据。
临床特征和影像学发现与支气管镜检查结果相对照。
分析了 103 名儿童（平均年龄为 2.7 岁，范围为 1 个月至 14 岁；73%为男孩，36%为女孩）的数据。大多数（73%）年龄小于 3 岁。85 例（83%）患儿经支气管镜检查证实为异物吸入。最常见的症状是突然窒息（74%）和阵发性咳嗽（73%）。在单变量（P=0.001、<0.001 和 0.001）和多变量分析（P=0.02、0.001 和 <0.001）中，目击吸入、窒息危机和单侧呼吸音减弱是异物吸入的独立预测因素。最敏感和特异的临床特征分别为窒息（86%）和目击吸入事件（89%）。有条件的胸部 X 线片显示 27%的患者有不透射线的物体。异物吸入的延迟诊断（>72 小时）在年龄较小的儿童中更为显著（t=3.29；P=0.001），以及无目击吸入史、阴性胸部检查和放射学征象的儿童中更为显著（P<0.001、P=0.02 和 P=0.04）。
为了避免延迟诊断，应在所有疑似病例中检查目击吸入、窒息危机、单侧呼吸音减弱和不透射线物体。当病史可疑时，无论影像学表现如何，只要有两个因素存在，都可以强烈推荐进行支气管镜检查。
