Janahi et al reported a clinical algorithm for managing a child with a suspected foreign body aspiration. The authors are from Hamad Medical Corporation and Weill Cornell Medicine-Qatar in Qatar.
Patient selection: child with suspected foreign body aspiration
Parameters:
(1) witnessed choking
(2) noisy breathing, stridor and/or dysphonia
(3) wheezing - new onset or recurrent or persistent
(4) chest X-ray findings
(5) unilateral reduced air entry
Parameter
Finding
Points
witnessed choking
no
0
yes
1
noisy breathing, stridor, dysphonia
no
0
yes
1
wheezing
no
0
yes
2
chest X-ray
normal
0
abnormal
2
unilateral reduced air entry
no
0
yes
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the greater the risk of aspiration.
• The authors used >= 2 as the cut-off.
• The maximum Youden was for >= 3 (sensitivity 75%; specificity 68%).
Score
Percent with Foreign Body
Management
0 or 1
10%
Close follow-up
2 or 3
30%
Flexible bronchoscopy
4 or 5
59%
Flexible or rigid bronchoscopy
6 or 7
71%
Prompt rigid bronchoscopy
Performance:
• The area under the ROC curve is 0.76.
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