Causes of delayed diagnosis of foreign body aspiration in children

2021 
Background: Foreign body aspiration (FBA) in the pediatric population is an emergency. However, after the choking episode, which can be forgotten or ignored, respiratory symptoms can alternate with asymptomatic periods, and the delayed diagnosis is often associated with the development of complications. Aim: study of causes which lead to diagnosis delay of a foreign body in the children’s airways. Methods: We present a descriptive study of 43 children with FBA, admitted to Pulmonology Clinic (2018-2020). Diagnosis was confirmed by bronchoscopy. To highlight the causes of late diagnosis, history, clinical and imaging data were evaluated. Results: Mean age of the children–1,6±0,49years. With the use of bronchoscopy, were removed, predominantly foreign bodies of vegetal organic origin: sunflower seeds 30,2%, walnuts pieces 18,6%, peanuts 9,3%. Only 39,5% of cases were diagnosed within 7 days of aspiration. Factors leading to diagnosis delay were: absence of history of penetration syndrome 26,9%(CI 11,6%-47,8%), absence of typical symptoms 7,7%(CI 0,9%-25,1%), chest x-ray without direct or indirect signs 19,2%(CI 6,6%-39,4%), mismanagement at the level of primary care 30,8% (CI 14,3%-51,8%), symptom ignorance by the parents 11,5%(CI 2,4%-30,2%), negative bronchoscopy 3,8%(CI 0,1%-19,6%). Complications of a delayed diagnosis were: pneumonia –53,8%, atelectasis –26,9%, bronchiectasis –3,8%, pleurisy –7,6%. Conclusions: Absence of history of penetration syndrome and specific radiological signs, as well as mismanagement of the case at the primary medical level are the most common causes of delay in diagnosis. The rate of bronchopulmonary complications increases as the diagnosis of foreign body aspiration is delayed.
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