Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Pulmonol. 2020 Mar;55(3):690-696. doi: 10.1002/ppul.24632. Epub 2020 Jan 7.
The diagnosis of foreign body aspiration (FBA) is challenging. In a previous study, we developed a computerized scoring system (CSS) to support decision-making. In the present study, we aimed to validate it on a further cohort.
In this observational study, 100 children referred to the emergency department of a tertiary pediatric hospital for suspected FBA and treated according to standard protocol, were assigned a probability score using the CSS, between 0 and 1 (0, very low probability; 1, very high). The diagnosis of FBA was based on bronchoscopy, and if discharged without bronchoscopy, determined via telephone questionnaire, 4 to 6 months after discharge, supplemented by clinical re-evaluation and bronchoscopy, if respiratory symptoms persisted.
Thirty-five out of 100 children (35%) underwent bronchoscopy with 12 of 35 (34%) positive for FBA. Sixty-five patients were discharged without bronchoscopy and completed a telephone questionnaire. Seven patients required clinical re-evaluation for persistent respiratory symptoms, in two out of them, additional bronchoscopies were performed and were negative. The CSS median probability score was 0.94 in patients with FBA, as compared to 0.73 in patients without FBA (P = .007). The CSS area under the receiver operating curve was 0.74. At a probability score threshold of 0.6, the sensitivity and specificity were 100% and 41%, respectively.
The present validation study suggests a high sensitivity of the CSS for the identification of FBA in children. We suggest that it might aid decision-making with regard to the need for bronchoscopy in children presenting to the emergency room.
异物吸入（FBA）的诊断具有挑战性。在之前的研究中，我们开发了一种计算机评分系统（CSS）以支持决策。本研究旨在进一步验证该系统。
在这项观察性研究中，100 名因疑似 FBA 而被转诊到一家三级儿科医院急诊科的儿童，根据标准方案使用 CSS 分配概率评分，范围为 0 到 1（0，极低概率；1，极高概率）。FBA 的诊断基于支气管镜检查，如果未行支气管镜检查，则在出院后 4 至 6 个月通过电话问卷调查确定，并在持续存在呼吸道症状时通过临床复查和支气管镜检查补充。
100 名儿童中有 35 名（35%）接受了支气管镜检查，其中 35 名中有 12 名（34%）为 FBA 阳性。65 名患者未行支气管镜检查并完成了电话问卷调查。7 名患者因持续呼吸道症状需要临床复查，其中 2 名患者进行了额外的支气管镜检查，结果均为阴性。有 FBA 的患儿 CSS 概率评分中位数为 0.94，无 FBA 的患儿为 0.73（P=0.007）。CSS 的受试者工作特征曲线下面积为 0.74。在概率评分阈值为 0.6 时，敏感性和特异性分别为 100%和 41%。
本验证研究表明，CSS 对儿童 FBA 的识别具有较高的敏感性。我们建议它可能有助于决策是否需要对急诊科就诊的儿童进行支气管镜检查。
