Janahi Ibrahim A, Khan Shabina, Chandra Prem, Al-Marri Noora, Saadoon Ammar, Al-Naimi Lolwa, Al-Thani Maryam, Greer William
Pediatric Pulmonology, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar.
Clinical Pediatrics, Weill Cornell Medicine-Qatar, Doha, Qatar.
BMC Pulm Med. 2017 Apr 13;17(1):61. doi: 10.1186/s12890-017-0406-6.
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.
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.
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.
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.
异物吸入（FBA）在儿童中是一个严重问题，诊断和治疗的延迟可能是灾难性的。病史往往不明确，体格检查和胸部X线表现细微异常。本研究旨在确定疑似FBA儿童进行支气管镜检查的指征，并根据患者就诊时的病史、体格检查和影像学检查结果，评估FBA的关键临床及具有统计学意义的预测因素。
这是一项回顾性观察性研究，纳入2001年1月至2011年1月因疑似FBA入院的患者。分析他们的就诊病史、体格检查、影像学和支气管镜检查结果。
纳入300名平均年龄为2.1±1.7岁的儿童。体格检查和影像学检查均异常的儿童中，47.2%确诊为FBA。若其中一项异常，可能性降至32 - 33.3%；若两项均正常，仅有7.4%有异物。目击窒息（校正OR 2.1，95%CI 1.03 - 4.3；P = 0.041）、呼吸嘈杂/喘鸣/声音嘶哑（校正OR 2.7，95%CI 1.2 - 6.2；P = 0.015）、新发/复发/持续性喘息（校正OR 4.6，95%CI 1.8 - 11.8；P = 0.002）、影像学检查异常（校正OR 4.0，95%CI 1.9 - 8.5；P < 0.001）以及单侧呼吸音减弱（校正OR 2.9，95%CI 1.5 - 5.5；P = 0.001）是FBA的显著预测因素（P < 0.05）。当存在三个或更多风险因素时，确诊为FBA的儿童累积比例显著增加。发现该模型的鉴别能力良好；ROC曲线下面积值为0.76（95%CI 0.70，0.82）。通过ROC分析得出的预测截断分数与已知的FBA临床显著预测因素相关性良好。这支持了我们的算法和评分系统。
诊断气道异物需要高度怀疑。我们提出的临床算法和评分系统希望能使医生准确预测FBA可能性高的患者。
