School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA.
Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA.
Am J Otolaryngol. 2023 Jul-Aug;44(4):103919. doi: 10.1016/j.amjoto.2023.103919. Epub 2023 May 5.
To better understand the diagnosis of foreign body aspiration by elucidating key components of its clinical presentation.
This is a retrospective cohort study of pediatric patients with suspected foreign body aspiration. We collected information regarding demographics, history, symptoms, physical exam, imaging, and operative findings for rigid bronchoscopies. An evaluation of these findings for an association with foreign body aspiration and the overall diagnostic algorithm was performed.
518 pediatric patients presented with 75.2 % presenting within one day of the inciting event. Identified history findings included wheeze (OR: 5.83, p < 0.0001) and multiple encounters (OR: 5.46, p < 0.0001). Oxygen saturation was lower in patients with foreign body aspiration (97.3 %, p < 0.001). Identified physical exam findings included wheeze (OR: 7.38, p < 0.001) and asymmetric breath sounds (OR: 5.48, p < 0.0001). The sensitivity and specificity of history findings was 86.7 % and 23.1 %, physical exam was 60.8 % and 88.4 %, and chest radiographs was 45.3 % and 88.0 %. 25 CT scans were performed with a sensitivity and specificity of 100 % and 85.7 %. Combining two components of the diagnostic algorithm yielded a high sensitivity and moderate specificity; the best combination was the history and physical exam. 186 rigid bronchoscopies were performed with 65.6 % positive for foreign body aspiration.
Accurate diagnosis of foreign body aspiration requires careful history taking and examination. Low-dose CT should be included in the diagnostic algorithm. The combination of any two components of the diagnostic algorithm is the most accurate for foreign body aspiration.
通过阐明其临床表现的关键组成部分，更好地了解异物吸入的诊断。
这是一项对疑似异物吸入的儿科患者进行的回顾性队列研究。我们收集了有关人口统计学、病史、症状、体格检查、影像学和硬性支气管镜检查的手术结果的信息。评估这些发现与异物吸入的关联以及整体诊断算法。
518 名儿科患者出现异物吸入，75.2%的患者在引发事件后 1 天内就诊。确定的病史发现包括喘息（OR：5.83，p<0.0001）和多次就诊（OR：5.46，p<0.0001）。异物吸入患者的血氧饱和度较低（97.3%，p<0.001）。确定的体格检查发现包括喘息（OR：7.38，p<0.001）和不对称呼吸音（OR：5.48，p<0.0001）。病史发现的敏感性和特异性分别为 86.7%和 23.1%，体格检查分别为 60.8%和 88.4%，胸部 X 线分别为 45.3%和 88.0%。25 例 CT 扫描的敏感性和特异性分别为 100%和 85.7%。结合诊断算法的两个组成部分可获得较高的敏感性和中等特异性；最佳组合是病史和体格检查。186 例硬性支气管镜检查中有 65.6%为异物吸入阳性。
异物吸入的准确诊断需要仔细的病史采集和检查。应将低剂量 CT 纳入诊断算法。诊断算法的任何两个组成部分的组合对异物吸入最准确。
