Risk factors associated with radiolucent foreign body inhalation in adults: a 10-year retrospective cohort study

The characteristics of occult foreign body aspiration and predicting factors in children

OBJECTIVE

To summarize the clinical characteristics and risk factors of occult foreign body aspiration (FBA) in children, which can help with early diagnosis and timely intervention, potentially preventing further exacerbations.

METHODS

We retrospectively analyzed the clinical data of the children with a final diagnosis of FBA by flexible bronchoscopy in our hospital from 2017 to 2023. The patients were divided into occult and typical groups, and two groups were compared. Multivariate binary logistic regression analysis was employed to identify risk factors associated with the occurrence of occult FBA.

RESULTS

Among 1031 patients, the incidence of occult FBA was 4.3 % (44 cases). Compared to the typical group, children in the occult group had higher odds of ventilator management (P = .006) and longer postoperative hospitalization time (P < .001). Risk factors for predicting occult FBA were identified as age greater than 3 years old [OR: 6. 918; 95%CI (3.150-15.191)], fever [OR: 2.323; 95%CI (1.092-4.939)], inspiratory laryngeal stridor [OR: 6.514; 95%CI (1.863-22.781)], atelectasis [OR: 3.372; 95%CI (1.418-8.020)], and infiltration [OR: 2.749; 95%CI (1.195-6.323)].

CONCLUSIONS

Unlike typical FBA, the diagnosis of occult FBA is far more challenging, and occult foreign bodies are linked to a further exacerbation. This study identifies a few risk factors that have the potential to facilitate an early diagnosis of occult FBA in children. Further multicenter studies should be conducted to validate the findings.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019

BACKGROUND

Foreign bodies (FBs) are a common emergency in medical institutions, that can occur in any area and among people of any age, which are common public health problems. Understanding the epidemiological characteristics of FBs is crucial for their prevention and control. The purpose of this study was to analyze the epidemiological characteristics of FBs worldwide through the data from the Global Burden of Disease Study 2019 (GBD 2019).

METHODS

We obtained data from the GBD 2019, which is an important public database to understand the disease burden of FBs. Joinpoint was used to analyze temporal trends in the incidence and death trends of FBs, which is widely used to study the long-term temporal trend of the burden of diseases. SaTScan was used to detect spatial-temporal clusters of pulmonary aspiration and foreign body in the airway (PAFBA), which is based on a Poisson model, scanning the number of people and diseases in the study area to obtain the spatial-temporal clusters of diseases.

RESULTS

Globally, the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) of FBs in 2019 were 869.23/100,000 (679.92/100,000-1120.69/100,000) and 1.55/100,000 (1.41/100,000-1.67/100,000), respectively. The ASIR and ASDR showed downtrends with average annual percent changes (AAPCs) of -0.31% and - 1.47% from 1990 to 2019. Of note, the ASIR showed an uptrend during 2010-2019, especially in high, high-middle, and middle SDI regions. Stratified analysis by age group showed that ASIR increased in each age group in recent years. From 1990 to 2019, the ASDR in the over-70 age group showed an uptrend worldwide, especially in high and high-middle SDI regions. In different types of FBs, the ASDR of PAFBA was the highest. The death burden of PAFBA was mainly clustered in 82 countries during 1993-2007, such as Canada, Cuba, and Mexico.

CONCLUSION

The most important goal is to improve public awareness and emergency knowledge of FBs through publicity methods, such as the internet or offline activities, and to improve laws and regulations. Additionally, different age groups need different targeted measures, such as strengthening the care of children, caring for elderly individuals, improving necessary monitoring programs and reporting systems, conducting effective hazard assessments, and publicity and education activities.