Author(s)
Michael Paap, BA1
Steven Zamora, MPH2
Shelby Leuin, MD3
Daniela Carvalho, MD
MMM3
Affiliation(s)
1UCSD, San Diego, CA, 2RCHSD, San Diego, CA, 3UCSD/RCHSD, San Diego, CA.
Abstract:
Introduction: Foreign body aspiration is a significant health problem which can result in life-threatening complications. The goal of this study was to assess which factors could affect outcomes in pediatric patients undergoing bronchoscopy for foreign body aspiration.
Methods: This is a retrospective case series study evaluating patients that underwent bronchoscopies due to foreign body aspiration at a tertiary pediatric hospital between 1/1/2010 and 12/6/2018. Data collected included demographic information, time of the aspiration event, history of developmental delay, time of the procedure, duration of the procedure, and outcome (discharged, admission to the hospital or intensive care unit (PICU) or deceased). Statistical analysis was performed using standard regression analysis and analysis of variance.
Results: There were a total of 114 patients that underwent bronchoscopy for foreign body aspiration (61% male and 39% females). The mean age was 2.8±3.4 years and 16% had developmental delay. The mean age for patients with developmental delay was 3.43 years, compared to 1.69 years for patients without developmental delay. The age difference between these two groups was statistically significant (p=0.0047). The most commonly aspirated object was food (57%), and patients were usually with their parents at the time of aspiration (78%). Most aspiration events (57%) happened between 4pm to 4am. The mean time of procedure was 38±28 minutes. The probability of admission to the hospital, PICU and death increased with the duration of the procedure (p<0.001). Patients with procedures longer than 60 minutes had a 40% probability of admission to the PICU, and patients with cases longer than 120 minutes had 13% probability of mortality.
Conclusion: Most foreign body aspirations occurred in the evening while the children were with their parents. Education of families regarding the risk of aspiration is crucial so they are always attentive to this issue. While the focus on prevention tends to be with younger patients, it is essential to emphasize the risk of foreign body aspiration in older patients with developmental delay. As most episodes of aspiration occur later in the day, it is imperative that tertiary pediatric centers ensure that the evening staff is trained and have the available equipment for these complex cases.