Clinical analysis of tracheobronchial foreign body aspiration in children aged six years and older

OBJECTIVE: Foreign body aspiration (FBA) occurs across all age groups but predominantly affects children under three years of age. Clinical evidence suggests that tracheobronchial foreign bodies in school-age children (> 6 years) present distinct characteristics in terms of foreign body types, clinical progression, and management strategies compared to younger children. This study aimed to analyze the clinical features and outcomes of school-age children who underwent rigid bronchoscopy for suspected FBA and to propose a clinically applicable management algorithm. MATERIALS AND METHODS: A retrospective single-center study was conducted involving 58 patients over six years of age who underwent rigid bronchoscopy for suspected foreign body aspiration between January 2019 and December 2023. All patients underwent imaging evaluation, including low-dose computed tomography (CT) following the ALARA principle when clinically indicated. RESULTS: The cohort included 51 males (87.9%) and 7 females (12.1%), with a mean age of 9.14 years (range: 6.17-13.83 years). The most common clinical manifestations were cough (94.8%) and wheezing (89.7%). Pen caps (43.1%) and watermelon seeds (17.2%) were the most frequently aspirated foreign bodies. Most patients (62.1%) presented within 24 h. Bronchoscopic removal was successful within 30 min in 56.9% of cases. Two patients (3.4%) required thoracotomy following unsuccessful bronchoscopic attempts. CONCLUSION: FBA in school-age children demonstrates distinct clinical characteristics, with non-food foreign bodies such as pen caps being predominant. Low-dose CT plays an important diagnostic role, while rigid bronchoscopy remains the primary treatment for central airway foreign bodies, and flexible bronchoscopy is useful for distal airway involvement. A structured algorithmic approach may facilitate timely diagnosis and appropriate intervention.