Lowe Emily, Soylu Erdinc, Deekonda Praveena, Gajaweera Hasitha, Ioannidis Dimitrios, Walker Woolf, Amonoo-Kuofi Kwamena
ENT Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, S016 6YD, United Kingdom.
Paediatric Respiratory Department, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom.
Int J Pediatr Otorhinolaryngol. 2024 Feb;177:111846. doi: 10.1016/j.ijporl.2023.111846. Epub 2023 Dec 31.
The aim of this study is to identify the most common and important features within the presenting history, clinical examination and chest radiograph that are associated with foreign body (FB) aspiration in the paediatric population, to support rationalised decision making in regards to proceeding with diagnostic bronchoscopy.
A retrospective notes review was conducted of 70 patients over a 12-year period at our tertiary referral centre. Their presenting history, clinical and radiographic signs were documented and univariate logistic regression model used to calculate odds ratios.
The main features identified within our cohort with a positive FB finding at bronchoscopy were history of a cough (OR 5.1, p = 0.008) and radiographic evidence of hyperinflation or air trapping (OR 7.1, p = 0.016). Zero patients with a FB presented with only a positive history in the absence of other clinical or radiological signs. History of a witnessed choking episode neither increased or decreased the likelihood of as aspirated FB (OR 1, p = 0.967).
We have identified two principal features, as described above, which are associated with paediatric FB aspiration. Reliance on a positive clinical history alone, but specifically the history of a witnessed choking episode, did not support the presence of a FB and other associated signs need to be considered in deciding to proceed to bronchoscopy.
本研究旨在确定儿科人群中，与异物（FB）吸入相关的现病史、临床检查及胸部X光片中最常见且重要的特征，以支持在决定是否进行诊断性支气管镜检查时做出合理决策。
在我们的三级转诊中心，对70例患者进行了为期12年的回顾性病历审查。记录他们的现病史、临床和影像学体征，并使用单因素逻辑回归模型计算比值比。
在我们的队列中，支气管镜检查发现FB阳性的主要特征为咳嗽史（比值比5.1，p = 0.008）及过度充气或气体潴留的影像学证据（比值比7.1，p = 0.016）。在没有其他临床或放射学体征的情况下，没有患者仅因现病史阳性就出现FB。目睹窒息发作史既未增加也未降低FB吸入的可能性（比值比1，p = 0.967）。
如上所述，我们确定了与儿科FB吸入相关的两个主要特征。仅依靠阳性现病史，特别是目睹窒息发作史，并不支持FB的存在，在决定是否进行支气管镜检查时，需要考虑其他相关体征。
