Reducing Unnecessary Bronchoscopies

OBJECTIVES: Pediatric foreign body aspiration (FBA) is a life-threatening emergency that may cause significant morbidity and mortality. Although bronchoscopy is the definitive diagnostic method, a considerable proportion of procedures are negative. Therefore, bronchoscopy decisions require accurate clinical and radiologic predictors. METHODS: This retrospective study included pediatric patients who underwent bronchoscopy for suspected FBA at the Kocaeli University Faculty of Medicine between January 2011 and March 2021. Demographic, clinical, and radiologic variables were analyzed. Among the 227 patients included in the study, 225 with complete clinical and radiologic data were included in the regression analyses. Univariable logistic regression was performed, and variables with P<0.10 were entered into a forced entry multivariable model. Model performance was evaluated using ROC analysis, the Hosmer-Lemeshow calibration test, and Nagelkerke R2. RESULTS: A total of 227 children were included, and foreign bodies were detected in 164 patients (72.6%). Most of the removed foreign bodies were organic (87.1%). On multivariable analysis, abnormal chest radiography (OR: 4.66; 95% CI: 2.43-8.92; P<0.001) and decreased unilateral breath sounds (OR: 2.57; 95% CI: 1.26-5.21; P=0.009) were independent predictors of positive bronchoscopy. The model showed acceptable discrimination (AUC: 0.738; 95% CI: 0.661-0.814) and good calibration (Hosmer-Lemeshow P=0.324). When an optimal cutoff of 0.56 was used, the sensitivity was 84.8%, and the specificity was 57.4%. A nomogram based on these predictors was constructed. CONCLUSIONS: In suspected pediatric FBA patients, abnormal chest x-rays and decreased breath sounds were identified as strong independent predictors of positive bronchoscopy. A nomogram based on these objective findings could help reduce unnecessary bronchoscopies and facilitate earlier treatment in high-risk patients.