The multivariate analysis of indications of rigid bronchoscopy in suspected foreign body aspiration E. Divarci * , B. Toker, Z. Dokumcu, A. Musayev, C. Ozcan, A. Erdener Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey article info Article history: Received 14 April 2017 Received in revised form 11 July 2017 Accepted 12 July 2017 Available online 14 July 2017 Keywords: Foreign body aspiration Bronchoscopy Rigid bronchoscopy Children abstract Objective: Foreign body aspiration (FBA) could be a serious life-threatening condition in children. Pa- tients usually underwent bronchoscopy with suspicious of FBA alone. In this study, we aimed to determine which patients need to go to bronchoscopy based on pre-operative findings. Methods: Retrospective analysis of patients underwent bronchoscopy between 1999 and 2015 was performed. Clinical symptoms, witnessed aspiration event (WAE), physical examination findings (PEFs) and radiological findings (RFs) were analyzed by multivariate analysis to evaluate the indications of bronchoscopy. Results: 431 patients (266M, 165F) underwent bronchoscopy with a median age of 2 years (7 months-16 years). A foreign body was detected in 68% of the patients. Univariate analysis demonstrated that wheeze was the sole distinctive clinical symptom for detection of FBA (p<0.001). The rates of positive WAE, PEFs and RFs were 83%, 71.7% and 36.9%, respectively. All of them were identified as independent predictive parameters in the detection of FBA by univariate analysis (p ¼ 0.003&p<0.001&p ¼ 0.015). Multivariate analysis was performed with considering the association between them. The rate of positive bron- choscopy was 91.3% in patients with positive WAE, PEFs and RFs together(84/92). In patients with a positive WAE alone who had not got PEFs and RFs, the rate of positive bronchoscopy was 34.2% (25/73). A foreign body was detected in 84% of the patients who had not got a WAE but positive PEFs and RFs together(21/25). Bronchial laceration was occurred in one patient during bronchoscopy. Pneumothorax was not seen in any of the other patients. The rate of mortality was 0.4% in the overall group (2 patients). Conclusion: The indications of bronchoscopy in suspected FBA are usually based on clinical suspicious. The definition of “ suspicous” could be a WAE or positive PEFs and RFs. The association of these factors increase the rate of positive bronchoscopies. In the light of our study, the classical indication for sus- pected FBA is still valid as “suspicious requires bronchoscopy”. © 2017 Published by Elsevier Ireland Ltd. 1. Introduction Foreign body aspiration (FBA) is a serious and common health problem in childhood which could cause significant morbidities and even mortality [1e5]. The types of aspirated foreign bodies could be varied according to the social and cultural characteristics and feeding habits of the parents and children [6]. Recurrent res- piratory disorders such as atelectasis, pneumonia or bronchiectasis could be seen as a result of late diagnosis of FBA, and occasionally requires surgical procedures like segmentectomy or lobectomy [7]. Therefore, an aggressive diagnostic approach which comprised rigid bronchoscopy under general anesthesia is usually advised to avoid overlooking the definite diagnosis of FBA [8,9]. The extended indications for rigid bronchoscopy result with a high percentage of negative bronchoscopies in children [10]. Pa- tients underwent bronchoscopy usually with a witnessed aspira- tion event for FBA alone. Is it really sufficient to perform a surgical procedure in a suspected child who has not got any clinical and/or radiological problems? Also, another substantial dilemma is in suspected patients without a witnessed aspiration event but have positive physical or radiological findings for FBA. Is it necessary to perform bronchoscopy in such cases without any aspiration his- tory? In this study, we aimed to present our surgical experience in * Corresponding author. Ege University Faculty of Medicine, Department of Pe- diatric Surgery, 35100 Bornova, Izmir, Turkey. E-mail addresses: emre.divarci@ege.edu.tr, e.divarci@gmail.com (E. Divarci), badetoker@gmail.com (B. Toker), z.dokumcu@gmail.com (Z. Dokumcu), allahverdi79@gmail.com (A. Musayev), coskunozcan11@gmail.com (C. Ozcan), ata. erdener@ege.edu.tr (A. Erdener). Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: http://www.ijporlonline.com/ http://dx.doi.org/10.1016/j.ijporl.2017.07.012 0165-5876/© 2017 Published by Elsevier Ireland Ltd. International Journal of Pediatric Otorhinolaryngology 100 (2017) 232e237