Tracheobronchial foreign body aspiration in children: how reliable are clinical and radiological signs in the diagnosis? Orji, F.T.* †‡ & Akpeh, J.O.* *Department of Otolaryngology, University Of Nigeria Teaching Hospital Enugu, Enugu,   Abia State University Teaching Hospital, Abia State Nigeria, Abia, and à Sunshine Hospital Umuahia, Abia State Nigeria, Abia, Nigeria Accepted for publication 24 September 2010 Clin. Otolaryngol. 2010, 35, 479–485 Objectives: To evaluate the yield of clinical and radio- logical features in the diagnosis of suspected foreign body aspiration in children and to assess factors associated with delayed diagnosis of foreign body aspiration. Study design and setting: Retrospective review of 10 years of experience in tertiary referral centre. Participants: Data were extracted from clinical records of children who underwent rigid bronchoscopy for suspected foreign body aspiration at the University of Nigeria Teaching Hospital Enugu from 2000 to 2009. Main outcome measures: Clinical features and radiological findings were validated against bronchoscopic findings. Results: Data of 103 children, (mean = 2.7 years, range =7 months to 14 years; 64% boys and 36% girls, were analysed. Majority (73%) were under 3 years of age. Foreign body aspiration was proven bronchoscopi- cally in 85 (83%) patients. The most common symp- toms were sudden choking crisis (74%) and paroxysms of cough (73%). Independent predictors of proven for- eign body aspiration were witnessed aspiration, choking crisis and unilateral decreased breath sounds in univari- ate (P= 0.001, <0.001, and 0.001 respectively) and multivariable analyses (P= 0.02, 0.001, and <0.001 respectively). The most sensitive and specific clinical features were choking (86%) and witnessed aspiration episode (89%), respectively. Available chest radiographs revealed radio-opaque objects in 27% of patients. Delayed diagnosis of foreign body aspiration (>72 h) was significantly more in younger children (t = 3.29; P = 0.001), as well as in children with no history of witnessed aspiration, negative chest examination and radiological signs (P < 0.001, P = 0.02 and P = 0.04 respectively). Conclusion: To prevent the delayed diagnosis, witnessed aspiration, choking crisis, unilateral decreased breath sounds and radiopaque objects should be checked in all suspected cases. When history is doubtful, regardless of radiological findings, bronchoscopy can be strongly recommended in the presence of two factors. Infants and young children tend to explore and place most objects in their mouths with attendant risk of for- eign body aspiration (foreign body aspiration) owing to their immature protective mechanisms. The morbidity and mortality are often higher in the younger age group, presumably because of relatively narrow airway in the later. 1–3 In some cases, there is definite history of aspira- tion event accompanied by choking and coughing bouts. However, a few cases of actual aspiration events are wit- nessed by parents or caregivers as children are sometimes allowed to play on their own unsupervised therefore resulting in doubtful history. 4–6 In children with doubtful history and associated nega- tive findings on physical examinations, the foreign body may remain undetected. In such cases, inflammation and granulation tissue may develop around the foreign body, and thus it is not uncommon for patients to be treated for other disorders such as persistent fever, asthma or recurrent pneumonia for a long period of time by paedia- tricians who are usually the first to see these patients resulting in delayed diagnosis and referral. 5–7 Delayed diagnosis is associated with increased incidence of com- plications. 6–9 A complication rate of 64% was reported to occur if diagnosis was made within 4–7 days and 95% if it was delayed for more than 30 days from the aspirating event. 8 Early diagnosis associated with prompt successful treatment is therefore mandatory for the management of foreign body inhalation. Rigid bronchoscopy is often performed for both defi- nite diagnosis and treatment because of the risks of over- looked foreign body aspiration, even when there is a little suspicion or doubtful history. 4,8–11 However, a survey of Correspondence: F.T. Orji, Department of Otolaryngology, University Of Nigeria Teaching Hospital Enugu, Enugu, Nigeria. Tel: 2348036773342; e-mail: tochiorji@yahoo.com ORIGINAL ARTICLE Ó 2010 Blackwell Publishing Ltd • Clinical Otolaryngology 35, 479–485 479