Pediatric Aerodigestive Foreign Body Injuries Are Complications Related to Timeliness of Diagnosis

TLDR

Foreign body injury from aspiration or ingestion is a common pediatric problem diagnosed through clinical judgment, history, physical examination, and radiographic evaluation. In a review of 1,269 pediatric foreign‑body events, 85 % were diagnosed after a single encounter, 15 % had delayed (>1 week) diagnoses—especially for aspirations (sevenfold more likely)—and secondary pulmonary injuries occurred in 13 % of airway cases versus 1.7 % of esophageal cases, underscoring the need for follow‑up surveillance to reduce pulmonary complications.

Abstract

Abstract Foreign body (FB) injury from aspiration or ingestion is a common pediatric health problem. Diagnosis relies on clinical judgment plus medical history, physical examination, and radiographic evaluation. A multi‐institutional review of 1269 FB events revealed that 85% were correctly diagnosed following a single physician encounter. However, 15% of the children had an elusive diagnosis(>1 week), despite previous evaluation. Delays in diagnosis were seven times more likely to occur in aspirations than in ingestions. Secondary injuries(e.g., pneumonia and atelectasis) occurred in 13% of airway FBs but in only 1.7% of esophageal FBs. Plain radiographs were used in 82% of children, and special studies (e.g., fluoroscopy) in only 7%. We conclude that diagnosis of FB injury in children is frequently achieved at the initial evaluation but that continued surveillance by follow‐up visits to health care facilities from parents and other caretakers is important, to reduce pulmonary injuries.