Penugonda Asha Jyothi, Devadas Ilakya, Valiaveetil Koshy Alan, Murugan Timri Palani, Antony Jovin Chris, Durai Balamurugan, Samuel J John, Kompithra Rajeev Zachariah, Mathai John, Adhikari Debasis Das
Paediatric Emergency Medicine Unit, Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
J Family Med Prim Care. 2024 Oct;13(10):4634-4641. doi: 10.4103/jfmpc.jfmpc_598_24. Epub 2024 Oct 18.
Definite history is not always present in children with foreign body aspiration (FBA), hence necessitating a high index of suspicion.
To assess the predictive value of clinico-radiological variables among children presenting with features of suspected FBA and to document their course in a tertiary care teaching hospital.
In this retrospective observational study, we included children aged below 15 years presenting with clinical features of suspected FBA. Data was obtained from case records. Multivariable binary logistic regression analysis (MVA) was performed to determine statistically significant predictors of FBA, and Weighted Risk Scores (WRS) were calculated to determine the significance of the model.
Of the 296 children included in the study and having undergone bronchoscopy, 84.5% were toddlers; 269 (90.87%) had a foreign body (FB) removed. Organic material was commonly found with 64.3% being peanut and right main bronchus, the commonest lodging site (50.6%). Of the 54 (18%) children with symptomatic but unwitnessed FBA, 45 (83.3%) had a FB retrieved. Choking with sudden onset cough, stridor, unilateral decreased breath sounds, abnormal chest radiograph, unilateral hyperinflation and mediastinal shift correlated with FBA ( < 0.05). MVA confirmed statistical significance with choking with sudden onset cough to predict FBA ( = 0.024) with overall sensitivity and specificity of 60.9% and 77.8%, respectively. Total WRS with cut-off >2 showed good power of discrimination with sensitivity, specificity and AUC of 60.2%, 77.8% and 0.704%, respectively.
The proposed predictive value-based scoring system enhances accuracy in decision-making regarding bronchoscopy in children with suspected FBA.
异物吸入（FBA）患儿并非总是有明确的病史，因此需要高度怀疑。
评估疑似FBA患儿临床放射学变量的预测价值，并记录其在三级护理教学医院的病程。
在这项回顾性观察研究中，我们纳入了15岁以下具有疑似FBA临床特征的儿童。数据来自病例记录。进行多变量二元逻辑回归分析（MVA）以确定FBA的统计学显著预测因素，并计算加权风险评分（WRS）以确定模型的显著性。
纳入研究并接受支气管镜检查的296名儿童中，84.5%为幼儿；269名（90.87%）取出了异物（FB）。常见的是有机物质，其中64.3%是花生，最常见的嵌顿部位是右主支气管（50.6%）。在54名（18%）有症状但无目击FBA的儿童中，45名（83.3%）取出了FB。突然发作的咳嗽、喘鸣、单侧呼吸音减弱、胸部X线异常、单侧肺过度充气和纵隔移位与FBA相关（<0.05）。MVA证实突然发作的咳嗽与预测FBA具有统计学显著性（=0.024），总体敏感性和特异性分别为60.9%和77.8%。截断值>2的总WRS显示出良好的鉴别能力，敏感性、特异性和AUC分别为60.2%、77.8%和0.704%。
所提出的基于预测价值的评分系统提高了疑似FBA患儿支气管镜检查决策的准确性。
