University of Southern Denmark Bronchoscopy in children suspected of lower airway aspiration Holst-Albrechtsen,

IntroductIon: Foreign body aspiration (FBA) of the bronchial tree may be a life-threatening condition in children. This retrospective study explores the anamnestic, clinical and objective findings in patients with FBA to the lungs and evaluates the frequency and outcome of the condition in patients in the age group of highest risk. Method: Medical files from patients below 18 years of age who had a foreign body removed from the lungs in our hospital were extracted using the procedure code for removal of foreign bodies in the lower airways (“Danish Patient Register”) in the period 1990-2013. results: In the period, a total of 49 children underwent endoscopic foreign body extraction and for 29 of the patients, the files were available for clinical data collection. The median age was 19 months. In nine patients (33%), no symptoms were recorded at admission. Thoracic X-ray was pathologic in 19 (67%) and pulmonary auscultation in 21 patients (73%). Two patients (7%) were in need of post-operative anaesthetic support as a result of respiratory failure, and the over-all complication rate was 28% (eight patients). No fatal outcomes were observed. conclusIons: The majority of the children in our study were in the 0-3-year age group. A raised suspicion of a foreign body in the lower airways should always trigger bronchoscopy. At admittance, not all patients present with respiratory symptoms. Although no deaths were observed, lower airway foreign body in small children remain a potentially life-threatening condition. FundIng: none. trIal regIstratIon: not relevant. Foreign body aspiration (FBA) of the lower airway may be associated with a high mortality rate and the diagnosis is a challenging task for the clinician, particularly in children. The symptomatic picture varies widely and, especially among children, the picture varies from no symptoms and objective findings at all to severe respiratory distress [1-11]. The incidence is highest within children in the 0-3-year age group, which constitutes 20% of all children with FBA to the lungs [1-9]. An explanation for this peak may be the lack of muscular coordination in the swallowing process together with a high activity level and distraction in the eating process. The children are missing molars for proper chewing and have immature neuromuscular mechanisms compared with adults who easily differentiate the chewing and swallowing functions from the respiratory process [7, 8]. The gold standard for diagnosing and treating FBA is rigid bronchoscopy [12]. This retrospective study investigates the anamnestic, clinical and objective findings in children with FBA of the lower airway. Furthermore, the study evaluates how often FBA occurs within children in the age group of highest risk. mEthOds This retrospective study is based on information from the patients’ medical files. The population was extracted from the “Danish Patients Register” using the codes for bronchoscopy and for endoscopic removal of a foreign body in the lower airways. The observation period is 1 January 1990 – 1 May 2013 (23.3 years; 280 months). Patients below 18 years of age were included. All patients had been treated at the Ear, Nose & Throat (ENT) Department, Hospital of South West Jutland, Denmark. A qualified estimate of the uptake population in the mentioned period for the hospital is 220,000 inhabitants. Bronchoscopy was performed in general anaesthesia using rigid bronchoscope and jet ventilation in all cases and supplemented with video-bronchoscopy when needed (Figure 1). The study was approved by the Danish Data Protection Agency. Non-parametric statistics were used. Trial registration: not relevant. REsUlts demography and epidemiology In the period 1 January 1990 – 1 Maj 2013, bronchoscopy was performed in 49 children below 18 years of age at the ENT Department due to anamnestic suspicion of FBA to the lower airways. Twenty of the patients were girls and 29 boys, with a median age of 19 months (range: 0.7-17 years). A foreign body was found in 29 of the 49 children (59%). The 29 children who had a foreign body extracted counted 11 girls and 18 boys with a median age of 24 months (range: 0.7-17 years). The 20 children (nine girls and 11 boys) in whom no foreign body was observed by bronchoscopy had a median age of 12 bronchoscopy in children suspected of lower airway aspiration Sine Holst-Albrechtsen, Søren Kristensen & Knud Larsen