Etiology-based management spectrum and outcomes of pediatric central airway stenosis: a retrospective cohort study

OBJECTIVE: This study aimed to describe the phenotypic characteristics, treatment strategies, and outcome spectrum of multi-factorial pediatric central airway stenosis, as well as to provide evidence for etiology-oriented individualized management of such cases. METHODS: We conducted a retrospective study by enrolling pediatric patients with central airway stenosis. Based on etiology, they were categorized into four groups: congenital, cardiogenic compression, dynamic, and acquired. We compared baseline characteristics (age stratification, gender, Myer-Cotton classification, stenosis location, stenosis length, Clinical Respiratory Score [CRS] severity) and relevant management strategies (follow-up observation, bronchoscopic interventional therapy, surgical intervention) across different etiological groups. Resultant outcomes were classified as either cured, improved, or ineffective; effective outcomes were defined as cured or improved. RESULTS: We enrolled 150 cases with a confirmed diagnosis of central airway stenosis (46 congenital, 66 cardiogenic compression, 21 dynamic, and 17 acquired). Significant differences were observed among the etiological groups regarding age stratification, Myer-Cotton classification, stenosis location, and CRS severity(p < 0.05). Treatment strategies were significantly correlated with the etiology. Acquired stenosis was primarily managed by flexible bronchoscopic intervention (94.1%), whereas cardiogenic compression stenosis and dynamic stenosis were predominantly managed with surgical intervention (69.7%) and follow-up observation (81.0%), respectively. All groups exhibited high overall efficacy rates (80.4%-94.1%); the cardiogenic compression stenosis group achieved an efficacy rate of 81.8% under surgical management. CONCLUSION: The clinical phenotype of pediatric central airway stenosis is significantly related to the etiology and treatment selection. Hence, the proposed management framework of 'etiology-based classification guiding clinical strategies' may support precise individualized treatment and is associated with favorable outcomes for such pediatric patients.