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TÜRKÇE
Poster - 143
How Has Our Management of Foreign Body Aspiration (FBA) in Children Evolved Over the Last Two Decades? A Recommendation for a Standardized Approach to Safe Foreign Body Removal
Kutay Bahadır 1, Denizcan İnal 1, Ege Ekiyor 1, Ergun Ergün 1, Ufuk Ateş 1, Gülnur Göllü 1, Özlem Selvi Can 2, Aydın Yağmurlu 1, Meltem Bingöl-Koloğlu 1
1 Ankara University Health Practice and Research Hospital, Department of Pediatric Surgery, Ankara
2 Ankara University Health Practice and Research Hospital, Department of Anesthesiology and Reanimation
Purpose:
This study aims to assess how our clinical approach to pediatric foreign body aspiration (FBA) has evolved over the past two decades. Emphasis is placed on the diagnostic strategies employed and the prevention of complications associated with bronchoscopy.
Methods:
We retrospectively reviewed pediatric patients who underwent bronchoscopy for suspected FBA between 2004 and 2024. Over the past three years, we implemented flexible bronchoscopy as a diagnostic tool in selected low-risk cases—defined by the absence of a reliable aspiration history and/or negative radiological findings. If a foreign body (FB) was identified, rigid bronchoscopy was performed for removal.
Results:
A total of 1,056 children (690 boys, 366 girls) with a mean age of 26.96 ± 0.8 months underwent 1,065 bronchoscopic procedures. Among 919 rigid bronchoscopies, FBs were retrieved in 637 patients (69.3%). Of 137 children who underwent diagnostic flexible bronchoscopy, 34 (24.8%) were confirmed to have FBs and subsequently underwent rigid bronchoscopy for removal.
There was a statistically significant association between FBA presence and both definite aspiration history (80.6% vs. 19.4%) and positive radiographic findings (88% vs. 12%) (p < 0.05). Sensitivity, specificity, and accuracy for clinical history were 92%, 62%, and 81%, respectively. For radiographic findings, these values were 74%, 83%, and 76%. When both were present, sensitivity was 77%, specificity 86%, and accuracy 80%.
Complications were observed in 61 patients (5.7%), including bronchospasm (n = 54) and bradycardia requiring resuscitation (n = 7). Since 2017, pre-procedural administration of β2-agonists and dexamethasone has been associated with a significant decrease in bronchospasm rates (5.7% vs. 1.6%, p < 0.05).
Conclusion:
Flexible bronchoscopy is a useful and safe diagnostic tool in selected low-risk cases. The prophylactic use of β2-agonists and steroids effectively reduces the rate of bronchoscopy-related complications.