Validation of a Foreign Body Aspiration Scoring System in Critically Ill Children: Retrospective Analysis of Outcomes and Bronchoscopy

Aim: Foreign body aspiration (FBA) is a common and potentially life-threatening emergency in pediatric patients.While bronchoscopy remains the gold standard for diagnosis, it carries procedural risks and may be unnecessary in a substantial number of cases.The Foreign Body Aspiration Score (FOBAS) was developed in order to improve diagnostic accuracy, but its utility in pediatric intensive care unit (PICU) settings has not been validated.This study aimed to externally validate the FOBAS system in a PICU population and assess its diagnostic performance and clinical applicability. Materials and Methods:In this single-centre retrospective cohort study, 54 children aged 1 month to 18 years, admitted to a PICU with suspected FBA and undergoing bronchoscopy between 2015 and 2024, were analysed.Demographics, clinical findings, imaging, and FOBAS parameters were evaluated.The association between FOBAS scores and bronchoscopy results was statistically analysed.Results: Of the 54 patients, 35 (64.8%) had a confirmed foreign body.The median FOBAS score was significantly higher in the positive group (7.0 vs. 3.0, p<0.001).Receiver operating characteristic analysis revealed excellent diagnostic performance (area under the curve: 0.910), with a cut-off of 6.5 providing 74.3% sensitivity and 88.5% specificity.Multivariate analysis identified foreign body exposure and total FOBAS score as independent predictors of positive bronchoscopy. Conclusion:FOBAS demonstrates high diagnostic accuracy in critically ill children with suspected FBA and may reduce unnecessary bronchoscopies in the PICUs.A cut-off score of 6.5 effectively stratifies risk and supports clinical decision-making in intensive care settings.