Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2021 Sep 1;147(9):787-796. doi: 10.1001/jamaoto.2021.1548.
Although various clinical prediction models (CPMs) have been described for diagnosing pediatric foreign body aspiration (FBA), to our knowledge, there is still no consensus regarding indications for bronchoscopy, the criterion standard for identifying airway foreign bodies.
To evaluate currently available CPMs for diagnosing FBA in children.
Performed in Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL database with citation searching of retrieved studies.
Prediction model derivation and validation studies for diagnosing FBA in children were included. Exclusion criteria included adult studies; studies that included variables that were not available in routine clinical practice and outcomes for FBA were not separate or extractable.
We followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies and the Prediction Model Risk of Bias Assessment Tool framework. Data were pooled using a random-effects model.
The primary outcome was the diagnosis of FBA as confirmed by bronchoscopy. Characteristics of CPMs and individual predictors were evaluated. The final model presentation with available measures of performance was provided by narrative synthesis. A meta-analysis of individual predictor variables and prediction models was performed.
After screening 4233 articles, 7 studies (0.2%; 1577 patients) were included in the final analysis. There were 6 model derivation studies and 1 validation study. Air trapping (odds ratio [OR], 8.3; 95% CI, 4.4-15.5), unilateral reduced air entry (OR, 4.8; 95% CI, 3.5-6.5), witnessed choking (OR, 3.1; 95% CI, 1.0-9.6), wheezing (OR, 2.5; 95% CI, 1.2-5.2), and suspicious findings suggestive of FBA on radiography (OR, 18.5; 95% CI, 5.0-67.7) were the most commonly used predictor variables. Model performance varied, with discrimination scores (C statistic) ranging from 0.74 to 0.88. The pooled weighted C statistic score of all models was 0.86 (95% CI, 0.80-0.92). All studies were deemed to be at high risk of bias, with overfitting of models and lack of validation as the most pertinent concerns.
This systematic review and meta-analysis suggests that existing CPMs for FBA in children are at a high risk of bias and have not been adequately validated. No current models can be recommended to guide clinical decision-making. Future CPM studies that adhere to recognized standards for development and validation are required.
尽管已经描述了各种用于诊断小儿异物吸入（FBA）的临床预测模型（CPM），但据我们所知，对于支气管镜检查的适应证仍没有共识，支气管镜检查是识别气道异物的金标准。
评估目前用于诊断儿童 FBA 的 CPM。
在 Ovid MEDLINE、Ovid Embase、PubMed、Web of Science 和 CINAHL 数据库中进行检索，并对检索到的研究进行了引文搜索。
纳入了用于诊断儿童 FBA 的预测模型推导和验证研究。排除标准包括成人研究；包括在常规临床实践中不可用的变量的研究，以及 FBA 结局不是单独或可提取的研究。
我们遵循了预测模型系统评价的关键评估和数据提取以及预测模型风险偏倚评估工具框架。使用随机效应模型对数据进行汇总。
主要结局是通过支气管镜检查确认的 FBA 诊断。评估了 CPM 和个体预测因子的特征。通过叙述性综合提供了具有可用性能测量值的最终模型演示。对个体预测变量和预测模型进行了荟萃分析。
在筛选了 4233 篇文章后，最终有 7 项研究（0.2%；1577 例患者）纳入最终分析。其中 6 项为模型推导研究，1 项为验证研究。气腔潴留（比值比 [OR]，8.3；95%CI，4.4-15.5）、单侧空气进入减少（OR，4.8；95%CI，3.5-6.5）、目睹窒息（OR，3.1；95%CI，1.0-9.6）、喘息（OR，2.5；95%CI，1.2-5.2）和影像学上提示异物吸入的可疑表现（OR，18.5；95%CI，5.0-67.7）是最常用的预测变量。模型性能差异较大，区分度评分（C 统计量）范围为 0.74 至 0.88。所有模型的汇总加权 C 统计量评分为 0.86（95%CI，0.80-0.92）。所有研究均被认为存在高偏倚风险，模型过度拟合和缺乏验证是最相关的问题。
本系统评价和荟萃分析表明，目前用于儿童 FBA 的 CPM 存在高偏倚风险，且尚未得到充分验证。目前没有模型可以推荐用于指导临床决策。需要遵循公认的开发和验证标准的未来 CPM 研究。
