Derivation of a clinical-radiological scoring system to predict foreign body aspiration in children
In brief
A 17-point score identified child foreign-body aspiration with 83% sensitivity
In a retrospective review of 274 bronchoscopies, a score combining seven clinical and chest X-ray findings predicted foreign-body aspiration with 83% sensitivity and 63% specificity at a cutoff of 7. Aspiration probability ranged from 24% for scores of 6 or less to 85% for scores of 10 or higher. The score needs validation before it can guide bronchoscopy decisions.
- Journal
- World journal of clinical pediatrics (Q1)
- Published
- 9 December 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Lianne Dmello, Tarun John K Jacob, Arun Kumar Loganathan
- PMID
- 42964677
- DOI
- 10.5409/wjcp.120948
Why clinicians should know about it
- Picked for Pediatric Surgery (top studies of the week, 1 November 2026): Paediatric emergency bronchoscopy selection for foreign body aspiration
Abstract
BACKGROUND: Foreign body aspiration (FBA) is a serious pediatric emergency in which delays in diagnosis and management may cause considerable morbidity. Although rigid bronchoscopy remains the procedure of choice, it is invasive and may be associated with complications. AIM: To derive a clinical scoring system to predict FBA and aid in the selection of children for bronchoscopy. METHODS: We performed a retrospective review of all children who underwent bronchoscopy for suspected FBA at our institute between 2013 and 2020. Clinical presentation, key historical features, examination findings, and radiological data were analyzed. Predictors of FBA were identified using regression analysis and weighted using adjusted odds ratios to develop a 17-point clinical-radiological score and an emergency decision-making algorithm. RESULTS: A total of 274 bronchoscopies were performed, with a negative bronchoscopy rate of 34%. Regression modelling identified seven independent predictors that were incorporated into the 17-point score: Definite choking history (2 points), respiratory distress (1 point), absence of concurrent upper respiratory tract infection (4 points), no history of asthma/reactive airway disease (3 points), unilateral decreased air entry/wheeze (2 points), tachypnea (1 point), and unilateral hyperinflation on chest radiograph (4 points). A cut-off score of 7 yielded a sensitivity of 83% and a specificity of 63% for predicting FBA. Risk stratification showed an increasing probability of FBA with higher scores: ≤ 6 points (24%), 7-9 points (51%), and ≥ 10 points (85%). CONCLUSION: While a low clinical threshold for bronchoscopy is often maintained in suspected FBA, the high negative bronchoscopy rate underscores the need for an objective tool to minimize unnecessary procedures without delaying intervention in high-risk children. The derived 17-point score demonstrated clinically useful discrimination ability and may support rational bronchoscopy selection.
Abstract as published, via PubMed.
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