Derivation of a clinical-radiological scoring system to predict foreign body aspiration in children
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.
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BibTeX
@article{dmello2026derivation,
title = {{Derivation of a clinical-radiological scoring system to predict foreign body aspiration in children}},
author = {Lianne Dmello and Tarun John K Jacob and Arun Kumar Loganathan},
journal = {World Journal of Clinical Pediatrics},
year = {2026},
month = nov,
doi = {10.5409/wjcp.120948},
url = {https://doi.org/10.5409/wjcp.120948},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Derivation of a clinical-radiological scoring system to predict foreign body aspiration in children
AU - Lianne Dmello
AU - Tarun John K Jacob
AU - Arun Kumar Loganathan
PY - 2026
DA - 2026/11/03
JO - World Journal of Clinical Pediatrics
DO - 10.5409/wjcp.120948
UR - https://doi.org/10.5409/wjcp.120948
AB - 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.
SN - 2219-2808
ER -