Corps étrangers trachéo-bronchiques chez l’enfant

Seasonal correlation and causal analysis of the incidence of bronchial foreign bodies in children

OBJECTIVE

To explore the seasonal correlation of the incidence of bronchial foreign body.

METHOD

Conduct retrospective analysis on clinical data of 1819 cases with bronchial foreign bodies in our hospital within an eight-year period (from January 2005 to January 2012), with cases classified into 12 groups by admission time (calculated by the Gregorian calendar in months, from January to December) and 4 groups by the Gregorian calendar in seasons (spring from March to May, summer from June to August, autumn from September to November, and winter from December to February), and observe whether the number of inpatients indicates any monthly or seasonal correlation.

RESULTS

The months of November and December indicated the highest number of inpatients, with 263 cases and 274 cases, which accounted for 12.7% and 13.2% of all reported cases, respectively. On the other hand, June and July had the lowest number of inpatients, with 96 cases and 75 cases, which accounted for 4.6% and 3.6%, respectively. Based on season, 749 cases were admitted in autumn, accounting for 35.1%; 636 cases were admitted in winter, accounting for 29.8%; 474 cases were admitted in spring, accounting for 22.2%; and 275 cases were admitted in summer, accounting for 12.9%. The number of inpatients was periodic, with 12 months as a cycle, and significant difference (P<0.01) was determined by comparing the numbers of inpatients in winter and spring and those in summer and spring.

CONCLUSIONS

The number of child in patients with bronchial foreign bodies is monthly periodic, with 12 months as a cycle, and respectively reaching the peak in November and December, and the valley in June and July; the seasonal characteristic was apparently related to the monthly characteristic, with the numbers of inpatients in autumn and winter each year being significantly higher than in the spring and summer, and the incidence showing apparent seasonal correlation. The results allow for the proposal of relevant precautionary measures against bronchial foreign bodies in children.

[Bronchoscopy for foreign body inhalation in the pediatric population: lessons learned from 223 cases]

INTRODUCTION

Inhalation of foreign body in children is a serious accident that may compromise the vital prognosis of the child. The diagnostic was difficult in the absence of a recognizable penetration syndrome. Bronchoscopy is still recommended as the appropriate diagnostic and treatment of foreign bodies. The purpose of this study was to analyze the diagnostic and the treatment result of bronchoscopy and discuss its indications.

MATERIAL AND METHODS

[corrected] A retrospective study analyzing data related to 223 children undergoing bronchoscopy due to suspicion of foreign body aspiration over a period of 10 years (2000-2009). The average age of the children was 29 months (range: one month-13 years). Approximately, two thirds of these patients were boys. The penetration syndrome was reported in 79.8% of cases.

RESULTS

During bronchoscopy, the foreign body was confirmed only in 57.4%. Foreign bodies were found in the bronchus in 79.7% of cases. Among the foreign bodies, 78.1% were of vegetal origin. The average time of stay of the foreign body was of 16.1 days. Penetration syndrome and abnormal physical exam were the most sensitive parameters (79.7% and 82.8%, respectively) but with low specificity (24.2% and 35.8%, respectively). The combination of clinical and radiological signs suggestive of foreign body was the most specific sign (74.7%). Similarly, we found a statistically significant correlation between positive bronchoscopy and simultaneous suggestive clinical and radiological signs (P=0.03). The multivariate study showed that predictors factors of positivity of the bronchoscopy were: abnormal physical exam (P=0.016), abnormal radiological exam (P=0.003) and type of indication (P=0.005).

DISCUSSION

The diagnosis of laryngotracheobronchial foreign body recures an array of arguments. It is suspected on the clinical interview specially penetration syndrome and on the clinical and radiological presentation. Any suspicion should lead to a bronchoscopy.