Negative bronchoscopy or computed tomography radiation in children with suspected foreign body aspiration? Pros and cons

Negative bronchoscopy or computed tomography radiation in children with suspected foreign body aspiration? 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Pros and cons Mehmet Emin Çelikkaya, Ahmet Atıcı, İnan Korkmaz, Çiğdem El, Mehmet Karadağ, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4522740/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Foreign body aspiration(FBA) remains an important cause of morbidity and mortality in childhood. Unfortunately, the clinical picture is often unclear and the clinician must decide which patients should undergo bronchoscopic evaluation. The aim of this study was to analyse patients who underwent bronchoscopy for suspected foreign body aspiration and to evaluate the properties of computed tomography(CT) in preventing unnecessary bronchoscopy, which carries the risk of serious complications. Methods: All patients younger than 18 years of age who were evaluated for foreign body aspiration at a tertiary children's hospital between June 2014 and February 2023 were included in the retrospective review. Results: A total of 165 children who underwent bronchoscopy were included in this study. 59.4% (n=98) of the cases were girls and 40.6% (n=67) were boys. The median age of the cases was 2 years, ranging from 0.5 to 18 years, and the interquartile range (Q3-Q1) value was 2. X-ray was performed in 100% of the cases (n=165) and CT scan was performed in 26.1% (n=43). In Group II (CT ± Bronchoscopy), the detection rate of FBA was 93%, whereas in Group I (only Bronchoscopy), it was significantly higher at 77.9% compared to 77.9%. Additionally, the negative diagnosis rate in Group II was significantly higher compared to Group I Conclusions: Low-dose chest CT is a highly effective imaging modality with high sensitivity and specificity for the diagnosis of FBA in children. Since it can be performed rapidly with minimal radiation exposure and can prevent unnecessary bronchoscopies in suspicious cases. Foreign body aspiration Negative bronchoscopy Low-dose computed tomography Figures Figure 1 Figure 2 Figure 3 Introduction Foreign body aspiration(FBA) remains an important cause of morbidity and mortality in childhood. It has been said to be the main cause of accidental deaths in the first year of life.[1] It is most commonly seen in children under 4 years of age and hypoxic brain damage and death can be observed if intervened late.[2] The main feature in clinical diagnosis is the presence of expulsive cough and laryngeal spasm as a respiratory defence reflex to aspiration of a foreign body. This clinical picture is called penetration syndrome. Penetration syndrome is characterised by cyanosis and asphyxia associated with coughing fits, but in 12 to 25% of cases the clinic may be silent. The most common clinical signs in the acute phase are wheezing, localised reduction or loss of vesicular breath sounds and intercostal retractions. In later periods, if the penetration syndrome is missed, the child frequently presents with a history of recurrent pneumonia in the same region [3]. It is very important to diagnose and remove the foreign body in the early period to reduce the incidence of mortality and postoperative complications. Significantly abnormal physical examination findings and positive findings on direct radiography (presence of a radiopaque foreign body, unilateral hyperexpansion or unilateral atelectasis) confirm the diagnosis and bronchoscopy should be performed in these patients [4]. Unfortunately, the clinical picture is often unclear and the clinician must decide which patients should undergo bronchoscopic evaluation [5]. Although direct radiographs are routinely used, they cannot exclude the diagnosis in the absence of positive findings, because approximately one third of patients with FBA have a normal chest X-ray [6]. Algorithms and multivariate models using anamnesis, physical examination and plain radiographs still have only about 70% sensitivity and 60% specificity [7, 8]. Rigid bronchoscopy, the gold standard for diagnosis and definitive treatment, remains an invasive procedure that requires exposure to anaesthesia in a patient with respiratory symptoms and carries the risk of exacerbation of reactive airway disease [5]. During bronchoscopy, complications ranging from transient desaturation to cardiac arrest occur at a rate of 2.6%-14%, and mortality at a rate of 0.42%-0.8%. In addition, in patients who underwent bronchoscopy with suspicion of FBA, the rate of confirmation of this diagnosis by bronchoscopy varies between 30% and 93% in the literatüre [5, 8, 9, 10]. Currently, the standard technique for bronchial foreign body removal in children is rigid bronchoscopy under general anaesthesia, but this technique is used very frequently for both diagnostic and therapeutic purposes, resulting in a negative bronchoscopy rate of 10% to 61%. [11,12]. Recent developments in multi-detector computed tomography (CT) have shortened the acquisition time and improved image quality. Since the acquisition time is only a few seconds in a co-operative patient, it can be performed in children without sedation. According to various studies, the bronchial sensitivity of multidetector CT in the diagnosis of FBA is close to 100% and the specificity is between 66.7% and 100%. False positive results are usually related to the presence of a mucus plug or artefact. No false negative results have been reported, but the sensitivity of this examination cannot be reliably determined because of the small sample sizes of the published series [3]. In addition, CT may provide the surgeon with precise information about the location and size of the bronchial foreign body, thus reducing the operative time in the patient undergoing rigid bronchoscopy. CT can also show associated lung lesions (emphysema, atelectasis, pneumothorax, bronchiectasis) [3, 14]. Therefore, there is a need for a diagnostic tool that is both superior to plain films and less invasive than bronchoscopy; this gap can potentially be filled by CT. The aim of this study was to retrospectively analyse patients who underwent bronchoscopy for suspected foreign body aspiration and to evaluate the properties of CT in preventing unnecessary bronchoscopy, which carries the risk of serious complications. Methods All patients younger than 18 years of age who were evaluated for foreign body aspiration at a tertiary children's hospital between June 2014 and February 2023 were included in the retrospective review. Patients were evaluated according to age, gender and aspiration material. The patients were divided into two groups. Group 1 consisted of patients who underwent bronchoscopy only. Group 2 patients consisted of patients who underwent CT and then bronchoscopy. Ethics committee permission dated 01/09/2022 and numbered 32 was obtained. All patients presented with a history of suspected aspiration or were referred for bronchoscopy by a pediatrician due to a history of frequent and recurrent pneumonia. Direct radiography was taken in all patients. Low-dose non-contrast computed tomography was performed on patients who were unremarkable on direct radiography but had a history of likely aspiration. Bronchoscopy was performed in patients with a foreign body seen on plain radiographs, patients with no foreign body seen on plain radiographs but a foreign body detected on CT, and patients with clinical complaints and a history of suspected aspiration regardless of radiological appearance. Patients who had no clinical complaints and no foreign body was observed on radiological imaging were hospitalized for 48 hours of observation. Images of all patients who underwent CT were evaluated by the same radiologist. All indicated patients underwent rigid bronchoscopy (Storz, Tutlingen, Germany) under general anaesthesia (inner diameter 3.5 mm, length 30 cm). Foreign bodies were removed with rigid grasping forceps. Patients who had problems waking up from anaesthesia postoperatively were followed up in intensive care unit, written informed consent was obtained from the parents of each paediatric patient before bronchoscopy was performed. Screening protocol CT scans were performed on a 64-slice Toshiba Aquilion unit (Toshiba Medical System Corporation, Otawara-Shi, Japan, Model TSX101A, 5 mm slice thickness). CT images were obtained in the supine position. CT scans were performed at low dose for the paediatric age group and without the use of any contrast agent. A lung window image sequence with a slice thickness of 3 mm was used for measurements. Statistical analysis Categorical variables were analyzed using Pearson chi-square tests with 2x2 tables. Sensitivty, specificity and accuracy analysis was performed to assess the potential diagnostic ability of both CT and X-Ray on FBA. Patients were considered to be true negatives if no foreign body was found on bronchoscopy. In addition, Kappa statistics were used to determine the between CT and X-ray agreement for the FBA diagnosis. The kappa statistic was interpreted as follows: less than 0.00, poor agreement; 0.00-0.20, slight agreement; 0.21-0.40, fair agreement; 0.41-0.60, moderate agreement; 0.61-0.80, substantial agreement; and 0.81-1.00, almost perfect agreement. SPSS for Windows (version 25.0; SPSS, Inc., Chicago, IL, USA) was used for analysis. A p value less than 0.05 was considered significant. Results A total of 165 children who underwent bronchoscopy were included in this study. It was observed that 59.4% (n=98) of the cases were girls and 40.6% (n=67) were boys. The median age of the cases was 2 years, ranging from 0.5 to 18 years, and the interquartile range (Q3-Q1) value was 2. X-ray was performed in 100% of the cases (n=165) and CT scan was performed in 26.1% (n=43). Other characteristics of the cases are presented in Table 1. Tablo 1. Baseline characteristics Sex n(%) Female 98 (59,4) Male 67 (40,6) Age median (IQR) 2 (1-3) History Cough Tachypnea Dyspne Decreased breath sounds Fever Stridor/ Wheeze Choking 118(71,5) 34(20,6) 21(12,7) 5(3) 3(1,8) 5(3) 2(1,2) X-ray n(%) FBA + 47 (28,5) FBA - 118 (71,5) CT n(%) Was taken 43 (26,1) Wasn’t taken 122 (73,9) CT n(%) FBA + 40 (93) FBA - 3 (74) CT (Location of Foreign Body) n(%) Trakea 2 (5) Sağ 20 (50) Sağ ve sol 1 (2,5) Sol 17 (42,5) Bronchoscopy n(%) FBA + 135 (81,8) FBA - 30 (18,2) Bronchoscopy (Location of Foreign Body) n(%) Trachea Carina 12 (8,8) 6( 4,4) Right main bronchus Right bronchus intermedius 12 (8,8) 18(13,3) Right and left bronchus 5 (3,7) Left main broncus 47 (34,9) Complications Bleeding Bronchospasm Desaturation Bradicardy Cardiac arrest 5(3) 8(5) 47 (34,9) 2(1,2) 1(0,6) Bronchoscopy-Only n(%) 122 (73,9) CT ± Bronchoscopy 43 (26,1) IQR:Q1-Q3 (n=165) The foreign bodies removed from the children are shown in Table 2. According to Table 2, the most common aspirated foreign body in children was peanut 29.2% (n=40), followed by kernel 13.14% (n=18) and needle 11.67% (n=16). 47 patients had positive findings on direct radiography. In 24 patients, aspirated opaque substances (needle, stone, pen tip, metal and tack) could be seen (Figure 1). In 23 patients, although no foreign body was seen in direct graphy, findings such as increased ventilation and atelectasis were observed(Figure 2). In one patient, two needles were observed at the same time, one was aspirated and the other was swallowed. In 2 patients, bronchoscopy was performed twice, one 2 months and one 4 months apart. Table 2. Distribution of removed foreign bodies Foreign Body n(%) Peanut 40 (29,2) Sunflower Seed 18 (13,14) Needle 16 (11,68) Hazelnut 7 (5,11) Walnut 6 (4,38) Almond 5 (3,65) Pumpkin Seeds 5 (3,65) Carrot 4 (2,92) Stone 4 (2,92) Watermelon Seeds 3 (2,19) Sweetcorn 3 (2,19) Ground Peanut 3 (2,19) Pea 2 (1,46) Piece Of Meat 2 (1,46) Pen Tip 2 (1,46) Haricot Bean 2 (1,46) Potatoes 2 (1,46) Broad Beans 1 (0,73) Bulgur Wheat 1 (0,73) Apple 1 (0,73) Cashew 1 (0,73) Pen Cap 1 (0,73) Chestnut 1 (0,73) Roasted Chickpea 1 (0,73) Metal 1 (0,73) Nylon 1 (0,73) Chickpeas 1 (0,73) Fastener 1 (0,73) Lentils 1 (0,73) Rosary Bead 1 (0,73) The presence of a foreign body detected by bronchoscopy was considered as the gold standard and the predictive values of CT and X-ray devices in detecting foreign bodies and their compatibility with each other were investigated (Table 3). Table 3. Compatibility and performance of CT and X-ray devices with bronchoscopy being the gold standard for detecting FBA Bronchoscopy FBA + (n=135) n(%) FBA - (n=30) n(%) Total (n=165) n(%) Sensitivity Spesificity Accuracy k (95%CI) p CT %100 %100 %100 1 (1-1) <0,001 FBA + 40 (100) 0 (0) 40 (93) FBA - 0 (0) 3 (100) 3(7) X-ray %34,1 %96,7 %45,4 0,144 (0,10-0,26) 0,001 FBA + 46 (34,1) 1 (3,3) 47 (28,5) FBA - 89 (65,9) 29 (96,7) 117 (71,5) CI: confidence İnterval, k :Kappa The sensitivity and specificity values of the CT for detecting the presence of foreign body were 100%, 100% and 100%, respectively, and the total accuracy rate was (40+3)/43=100%. The compatibility of the CT with the bronchoscopy was determined to be at a statistically significant 1 (95% CI:1-1;p<0.001) substantial agreement level. When the results were analysed, it was determined that the sensitivity of the X-Ray device in detecting the presence of foreign body was 34.1%, the specificity was 96.7%, and the total accuracy was (46+29)/165=45.4%. The agreement between CT with the bronchoscopy device was at a statistically significant 0.144 (95% CI: 0.10-0.26;p=0.001) at slight agreement level. The agreement between X-RAY and CT devices used to detect the presence of foreign bodies in children was analysed (Table 4). Table 4. Compatibility of CT and X-ray devices CT FBA + (n=40) n(%) FBA - (n=3) n(%) Total (n=43) n(%) k (95%CI) p X-ray 0,06 (0,01-0,28) 0,237 Pozitif 13 (32,5) 0 (0) 13 (30,2) Negatif 27 (67,5) 3 (100) 30 (69,8) CI: confidence İnterval, k :Kappa According to table 4, it was determined that the compatibility between X-RAY and CT devices was not statistically significant. Table 5. Comparing groups in terms of FBA diagnosis Group I (n=122) Group II (n=43) Total p n(%) n(%) n(%) FBA + 95 (77,9) 40 (93) 135 (81,8) 0,027 FBA - 27 (22,1) 3 (7) 30 (18,2) Group I: Bronchoscopy-Only, Group II: CT ± Bronchoscopy, p value was obtained from Pearson Chi Square test. It was determined that there were statistically significant differences between groups in detecting FBA (p=0.027). In Group II (CT ± Bronchoscopy), the detection rate of FBA was 93%, whereas in Group I (only Bronchoscopy), it was significantly higher at 77.9% compared to 77.9%.(Figüre 3) Additionally, it was observed that the negative diagnosis rate in Group II was significantly higher compared to Group I (Table 5). Discussion Foreign body aspiration in children is a potentially serious household accident that is a frequent presenting complaint to paediatric emergency departments [ 15 ]. More than 80% of foreign body aspiration cases occur in early childhood and the highest incidence is observed between 10 and 24 months. The absence of molars and premolars and the tendency to bring all objects to the mouth explain the special predisposition of children in this age group [ 16 , 17 ]. Symptoms may vary significantly according to the location of the foreign body in the airways. When the foreign body is trapped in the larynx or trachea, respiratory distress or stridor immediately suggests the diagnosis. However, in the vast majority of cases (75 to 94 per cent) the foreign body migrates into the bronchi and clinical symptoms are much less persistent.[ 11 , 18 ]. Since the risk of complications related to the presence of a bronchial foreign body increases with the passage of time, it is important to make the diagnosis as soon as possible (3). Currently, the standard technique for the treatment of foreign body aspiration in children is rigid bronchoscopy under general anaesthesia, but this technique is used very frequently for both diagnostic and therapeutic purposes, resulting in a negative bronchoscopy rate of 10–61%.[ 3 , 19 ] Most authors have stated that rigid bronchoscopy is the standard technique for the removal of bronchial foreign bodies in children with a success rate of more than 97% [ 6 , 16 , 20 ]. In our study, rigid bronchoscopy was negative in 30 patients among 165 patients. The rate of negative rigid bronchoscopy was 18.1%. All of these patients were in the non-CT patient population. According to various authors, the complication rate related to rigid bronchoscopy varies between 2% and 22%. The most common complications are laryngeal oedema and pneumothorax, but more serious complications such as tracheal tear, bronchial tear, hypoxia and cardiorespiratory arrest may also occur. Fortunately, these complications are rare.[ 3 , 6 ]. Because of these rare but serious complications, it is important to reduce the rate of negative rigid bronchoscopy[ 3 ]. The skills and clinical experience of the surgeon and anaesthetist are also very important for the bronchoscopy procedure. Anaesthetists and surgeons should be aware of the severity of complications and have a plan to manage postoperative complications [ 13 ]. In our patients, intra-bronchial haemorrhage occurred in 5 patients, low oxygen saturation and bronchospasm in 8 patients, bradycardia in 2 patients and cardiac arrest in 1 patient who returned to sinus rhythm with cardiac massage. No bronchoscopy-related mortality was observed in our patients. According to Silva et al., the sensitivity and specificity of chest radiography increases when chest radiography is performed 24 hours after aspiration [ 21 ]. In the acute phase, the sensitivity and specificity of chest radiography for the diagnosis of bronchial foreign body is low[ 22 ] and it is reported to be normal in 14 to 37% of cases in many studie [ 12 , 23 , 24 ]. In our study, 46(34.1%) of 135 patients who had detected FBA on bronchoscopy had positive findings on DG. In 89 (65.9%) patients in whom FBA was detected in bronchoscopy, no finding in favour of FBA was observed on direct radiography. Hegde et al. reported that CT was superior to plain films in the detection of foreign bodies in the respiratory tract[ 25 ]. Behera et al. evaluated patients who underwent CT and bronchoscopy for FBA and found that 59/60 of them were confirmed. The remaining case, which was suspicious on CT, was found to be a thick mucus plug by rigid bronchoscopy [ 26 ]. Gibbons et al. compared 64 patients who underwent bronchoscopy only with 69 patients who underwent CT and bronchoscopy and reported that the diagnosis of foreign body was excluded in 49 patients with CT and unnecessary bronchoscopy was prevented [ 5 ]. In our study, 165 paediatric patients who underwent bronchoscopy were evaluated and no foreign body was observed in 30 patients. In a group of 122 patients who underwent bronchoscopy alone, no foreign body was observed in 27 patients (22%), whereas in a group of 43 patients who underwent CT, no foreign body was observed in bronchoscopy performed because of the anamnesis and intense dyspnoea in the patients, although CT was negative in 3 patients (7%). In our study, the rate of negative bronchoscopy decreased from 22–7% in the CT group compared to the bronchoscopy only group. Qiu et al., in a 7-year study evaluating 48 patients who aspirated FB and had false negativity on CT, stated that 43.9% of the aspirated material consisted of sheet or dust. It was also stated that in more than 50% of the patients, the diagnosis was made at least 2 weeks later, and it took up to 2 years at the longest. It has also been stated that the image may be confused with pneumonia due to lung infiltrates in these patients [ 27 ]. In our study, the application period of the patients was between the same day and one month, and the number of patients with lung infiltration was only 2 (1.2%). Kim et al stated in their study that: In addition to the use of CT preventing unnecessary bronchoscopies, the use of CT for diagnosis in suspicious cases can potentially prevent missed diagnosis in clinically suspicious cases, which can occur in up to 20% of cases with plain films [ 2 ]. Çiftçi et al. stated that up to 33% of FBA cases can be misdiagnosed as pneumonia based on clinical findings alone[ 6 ]. In our study, it was observed that 2 of 3 patients with negative FB on bronchoscopy had an asthma attack and one patient had pneumonia. Another potential benefit of using CT to diagnose FB is its applicability for triage in public hospitals where a pediatric surgeon is not available. In these hospitals, unnecessary transfer to the referral hospital can be prevented in case of CT negativity [ 5 ]. In our study, 12 patients first applied to an external center and were referred to us upon detection of FB on CT. Conclusion Positive clinical diagnosis of FBA is often difficult because of the low sensitivity and specificity of penetration syndrome and pulmonary auscultation. Therefore, complementary radiological examinations play an important role in reducing the rate of negative rigid bronchoscopy in children with suspected bronchial foreign bodies. Rigid bronchoscopy should always be performed as a first-line procedure in the presence of a radiopaque, obstructive foreign body on chest radiography or in the presence of characteristic clinical and radiographic signs. In doubtful cases, the presence of a foreign body should be confirmed by CT. Low-dose chest CT is a highly effective imaging modality with high sensitivity and specificity for the diagnosis of FBA in children. Since it can be performed rapidly with minimal radiation exposure and can prevent unnecessary bronchoscopies, it should be used in suspicious cases. Declarations Ethics approval: The study was approved by the Hatay Mustafa Kemal University, Faculty of Medicine and carried out according to the Declaration of Helsinki. Consent for publication: All authors consent for manuscript submission. Competing interests: The authors declare no competing interests. Author Contribution All authors contributed to the study conception and design. Material preparation and data collection were performedby M.E.Ç., Ç.E., İ.K. Data analysis was performed by M.E.Ç., M.K., A.A. Manuscript writing and review were performed by M.E.Ç., B.A., İ.K. All authors approved the final manuscript. References Fasseeh NA, Elagamy OA, Gaafar AH, Reyad HM (2021) A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a retrospective cohort study. 47(1):194 Kim IA, Shapiro N, Bhattacharyya N (2015) The national cost burden of bronchial foreign body aspiration in children. Laryngoscope 125(5):1221–1224 Hitter A, Hullo E, Durand C, Righini CA (2011) Diagnostic value of various investigations in children with suspected foreign body aspiration: review. Eur annals Otorhinolaryngol head neck Dis 128(5):248–252 Even L, Heno N, Talmon Y, Samet E, Zonis Z, Kugelman A (2005) Diagnostic evaluation of foreign body aspiration in children: a prospective study. 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Thorac Cardiovasc Surg 55:249–252 Silva AB, Muntz HR, Clary R (1998) Utility of conventional radiography in the diagnosis and management of pediatric airway foreign bodies. Ann Otol Rhinol Laryngol 107(10 Pt 1):834–838 Mu LC, Sun DQ, He P (1990) Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases. J Laryngol Otol 104(10):778–782 Cataneo AJ, Cataneo DC, Ruiz RL (2008) Management of tracheobronchial foreign body in children. Pediatr Surg Int 24(2):151–156 Zaupa P, Saxena AK, Barounig A, Höllwarth ME (2009) Management strategies in foreign-body aspiration. Indian J Pediatr 76(2):157–161 Hegde SV, Hui PKT, Lee EY (2015) Tracheobronchial foreign bodies in children: imaging assessment. Seminars in Ultrasound, CT and MRI. ;36:8–20. https://doi.org/10.1053/j.sult.2014.10.001 Behera G, Tripathy N, Maru YK et al (2014) Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree. J Laryngology Otology 128:1078–1083. https://doi.org/10.1017/S0022215114002837 Qiu W, Wu L, Chen Z (2019) Foreign body aspiration in children with negative multi-detector Computed Tomography results: Own experience during 2011–2018. Int J Pediatr Otorhinolaryngol 124:90–93 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4522740","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":315286719,"identity":"5344fcb3-d28b-4ec3-86ba-049ca0bec7c5","order_by":0,"name":"Mehmet Emin Çelikkaya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYFACxgYgISdnAOYYWBCrJcHY2ICBGaRFglibEowTN4C1MBChhV/scNuDnz8M0rez9x/d8KNAgoG/vTsBrxbJ2Ynthj0JBrk7ew6z3ewBOkzizNkNeLUY3E5sk2ZI+JO74UYy2w0eoBYDiVz8WuwhWgzSDYBabv4hRouBNERLAkjLbaJskQDaItmTZmC44cxhs9syBhI8BP3CPzv9mcQPGwN5g+ONz26++WMjx9/ei18LBuAhTfkoGAWjYBSMAqwAAK9zQ9Pm60S3AAAAAElFTkSuQmCC","orcid":"","institution":"Mustafa Kemal University","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"Emin","lastName":"Çelikkaya","suffix":""},{"id":315286720,"identity":"76f5515a-b45e-41d1-8c7b-ecd2fdee695b","order_by":1,"name":"Ahmet Atıcı","email":"","orcid":"","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"","lastName":"Atıcı","suffix":""},{"id":315286721,"identity":"4560d1e1-5442-44f4-affc-cda0c758a5b0","order_by":2,"name":"İnan Korkmaz","email":"","orcid":"","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"İnan","middleName":"","lastName":"Korkmaz","suffix":""},{"id":315286722,"identity":"bd9ef414-98b8-4349-9369-b97e0fdb2b64","order_by":3,"name":"Çiğdem El","email":"","orcid":"","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Çiğdem","middleName":"","lastName":"El","suffix":""},{"id":315286723,"identity":"0bf2beba-cd03-499d-a4f5-79c76d166c7a","order_by":4,"name":"Mehmet Karadağ","email":"","orcid":"","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Karadağ","suffix":""},{"id":315286724,"identity":"574cc3a6-603d-4ed2-a51c-84da28704fe3","order_by":5,"name":"Bülent Akçora","email":"","orcid":"","institution":"Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Bülent","middleName":"","lastName":"Akçora","suffix":""}],"badges":[],"createdAt":"2024-06-03 15:16:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4522740/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4522740/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58753435,"identity":"22cdc01a-f9f1-479b-ade3-4bef252e19b0","added_by":"auto","created_at":"2024-06-20 16:18:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":746036,"visible":true,"origin":"","legend":"\u003cp\u003eRadiopaque foreign bodies A. Needle, B.Pen tip, C.Stone\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4522740/v1/7e131e424835c1b1a83bcb43.png"},{"id":58754292,"identity":"5271aba6-f9bf-4e4c-af99-214b78d52831","added_by":"auto","created_at":"2024-06-20 16:26:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":667815,"visible":true,"origin":"","legend":"\u003cp\u003eA. Atelectasis obliterating the left heart contour, B. Negative CT image, density in favor of foreign body that almost completely obliterates the airway (white arrow), C. Normal chest x-ray after braonchoscopy\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4522740/v1/7384a38cb362db3cfe929155.png"},{"id":58753437,"identity":"9d01cbe4-2867-4df6-af50-efdc0de070f7","added_by":"auto","created_at":"2024-06-20 16:18:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":827536,"visible":true,"origin":"","legend":"\u003cp\u003eA. Normal chest x-ray B. Foreign body in the right main bronchus(black arrow) in axial CT image (although it is not observed in normal radiographs, hyperaeration in the right lung is noticeable on CT). C.Foreign body in sagittal CT image\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4522740/v1/716dd3b83225b7f15010b8ea.png"},{"id":60405069,"identity":"648c9a66-0c37-4860-a402-0fcb0d45a0e9","added_by":"auto","created_at":"2024-07-16 11:53:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3674380,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4522740/v1/44ee8178-2356-4d79-aa60-e2d4ac56e9e5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Negative bronchoscopy or computed tomography radiation in children with suspected foreign body aspiration? Pros and cons","fulltext":[{"header":"Introduction","content":"\u003cp\u003eForeign body aspiration(FBA) remains an important cause of morbidity and mortality in childhood. It has been said to be the main cause of accidental deaths in the first year of life.[1] It is most commonly seen in children under 4 years of age and hypoxic brain damage and death can be observed if intervened late.[2] The main feature in clinical diagnosis is the presence of expulsive cough and laryngeal spasm as a respiratory defence reflex to aspiration of a foreign body. This clinical picture is called penetration syndrome. Penetration syndrome is characterised by cyanosis and asphyxia associated with coughing fits, but in 12 to 25% of cases the clinic may be silent. The most common clinical signs in the acute phase are wheezing, localised reduction or loss of vesicular breath sounds and intercostal retractions. In later periods, if the penetration syndrome is missed, the child frequently presents with a history of recurrent pneumonia in the same region [3]. It is very important to diagnose and remove the foreign body in the early period to reduce the incidence of mortality and postoperative complications.\u003c/p\u003e\n\u003cp\u003eSignificantly abnormal physical examination findings and positive findings on direct radiography (presence of a radiopaque foreign body, unilateral hyperexpansion or unilateral atelectasis) confirm the diagnosis and bronchoscopy should be performed in these patients [4]. Unfortunately, the clinical picture is often unclear and the clinician must decide which patients should undergo bronchoscopic evaluation [5]. Although direct radiographs are routinely used, they cannot exclude the diagnosis in the absence of positive findings, because approximately one third of patients with FBA have a normal chest X-ray [6]. Algorithms and multivariate models using anamnesis, physical examination and plain radiographs still have only about 70% sensitivity and 60% specificity [7, 8]. Rigid bronchoscopy, the gold standard for diagnosis and definitive treatment, remains an invasive procedure that requires exposure to anaesthesia in a patient with respiratory symptoms and carries the risk of exacerbation of reactive airway disease [5]. \u0026nbsp;During bronchoscopy, complications ranging from transient desaturation to cardiac arrest occur at a rate of 2.6%-14%, and mortality at a rate of 0.42%-0.8%. In addition, in patients who underwent bronchoscopy with suspicion of FBA, the rate of confirmation of this diagnosis by bronchoscopy varies between 30% and 93% in the literat\u0026uuml;re [5, 8, 9, 10]. Currently, the standard technique for bronchial foreign body removal in children is rigid bronchoscopy under general anaesthesia, but this technique is used very frequently for both diagnostic and therapeutic purposes, resulting in a negative bronchoscopy rate of 10% to 61%. [11,12].\u003c/p\u003e\n\u003cp\u003eRecent developments in multi-detector computed tomography (CT) have shortened the acquisition time and improved image quality. Since the acquisition time is only a few seconds in a co-operative patient, it can be performed in children without sedation. According to various studies, the bronchial sensitivity of multidetector CT in the diagnosis of FBA is close to 100% and the specificity is between 66.7% and 100%. False positive results are usually related to the presence of a mucus plug or artefact. No false negative results have been reported, but the sensitivity of this examination cannot be reliably determined because of the small sample sizes of the published series [3]. In addition, CT may provide the surgeon with precise information about the location and size of the bronchial foreign body, thus reducing the operative time in the patient undergoing rigid bronchoscopy. CT can also show associated lung lesions (emphysema, atelectasis, pneumothorax, bronchiectasis) [3, 14]. Therefore, there is a need for a diagnostic tool that is both superior to plain films and less invasive than bronchoscopy; this gap can potentially be filled by CT. The aim of this study was to retrospectively analyse patients who underwent bronchoscopy for suspected foreign body aspiration and to evaluate the properties of CT in preventing unnecessary bronchoscopy, which carries the risk of serious complications.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAll patients younger than 18 years of age who were evaluated for foreign body aspiration at a tertiary children\u0026apos;s hospital between June 2014 and February 2023 were included in the retrospective review. Patients were evaluated according to age, gender and aspiration material. The patients were divided into two groups. Group 1 consisted of patients who underwent bronchoscopy only. Group 2 patients consisted of patients who underwent CT and then bronchoscopy. Ethics committee permission dated 01/09/2022 and numbered 32 was obtained. All patients presented with a history of suspected aspiration or were referred for bronchoscopy by a pediatrician due to a history of frequent and recurrent pneumonia. Direct radiography was taken in all patients. Low-dose non-contrast computed tomography was performed on patients who were unremarkable on direct radiography but had a history of likely aspiration. Bronchoscopy was performed in patients with a foreign body seen on plain radiographs, patients with no foreign body seen on plain radiographs but a foreign body detected on CT, and patients with clinical complaints and a history of suspected aspiration regardless of radiological appearance. Patients who had no clinical complaints and no foreign body was observed on radiological imaging were hospitalized for 48 hours of observation. Images of all patients who underwent CT were evaluated by the same radiologist.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll indicated patients underwent rigid bronchoscopy (Storz, Tutlingen, Germany) under general anaesthesia (inner diameter 3.5 mm, length 30 cm). Foreign bodies were removed with rigid grasping forceps. Patients who had problems waking up from anaesthesia postoperatively were followed up in intensive care unit, written informed consent was obtained from the parents of each paediatric patient before bronchoscopy was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScreening protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCT scans were performed on a 64-slice Toshiba Aquilion unit (Toshiba Medical System Corporation, Otawara-Shi, Japan, Model TSX101A, 5 mm slice thickness). CT images were obtained in the supine position. CT scans were performed at low dose for the paediatric age group and without the use of any contrast agent. A lung window image sequence with a slice thickness of 3 mm was used for measurements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCategorical variables were analyzed using Pearson chi-square tests with 2x2 tables. Sensitivty, specificity and accuracy analysis was performed to assess the potential diagnostic ability of both CT and X-Ray on FBA. Patients were considered to be true negatives if no foreign body was found on bronchoscopy. In addition, Kappa statistics were used to determine the between CT and X-ray agreement for the FBA diagnosis. The kappa statistic was interpreted as follows: less than 0.00, poor agreement; 0.00-0.20, slight agreement; 0.21-0.40, fair agreement; 0.41-0.60, moderate agreement; 0.61-0.80, substantial agreement; and 0.81-1.00, almost perfect agreement. SPSS for Windows (version 25.0; SPSS, Inc., Chicago, IL, USA) was used for analysis. A p value less than 0.05 was considered significant.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 165 children who underwent bronchoscopy were included in this study. It was observed that 59.4% (n=98) of the cases were girls and 40.6% (n=67) were boys. The median age of the cases was 2 years, ranging from 0.5 to 18 years, and the interquartile range (Q3-Q1) value was 2. X-ray was performed in 100% of the cases (n=165) and CT scan was performed in 26.1% (n=43). Other characteristics of the cases are presented in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTablo 1. Baseline characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"553\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e98 (59,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e67 (40,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eAge median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e2 (1-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCough \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTachypnea \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDyspne \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDecreased breath sounds \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFever \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eStridor/ Wheeze \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eChoking \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e118(71,5)\u003c/p\u003e\n \u003cp\u003e34(20,6)\u003c/p\u003e\n \u003cp\u003e21(12,7)\u003c/p\u003e\n \u003cp\u003e5(3)\u003c/p\u003e\n \u003cp\u003e3(1,8)\u003c/p\u003e\n \u003cp\u003e5(3)\u003c/p\u003e\n \u003cp\u003e2(1,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX-ray \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFBA +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u0026nbsp;47 (28,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFBA -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e118 (71,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eWas taken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e43 (26,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eWasn\u0026rsquo;t taken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e122 (73,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFBA +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e40 (93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFBA -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e3 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT (Location of Foreign Body)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eTrakea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e2 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eSağ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e20 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eSağ ve sol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e1 (2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eSol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e17 (42,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBronchoscopy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFBA +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e135 (81,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eFBA -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e30 (18,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"89.69258589511755%\" colspan=\"2\" style=\"width: 96.7742%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBronchoscopy (Location of Foreign Body) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eTrachea\u003c/p\u003e\n \u003cp\u003eCarina \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e12 (8,8)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6( 4,4) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eRight main bronchus\u003c/p\u003e\n \u003cp\u003eRight bronchus intermedius \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e12 (8,8) 18(13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eRight and left bronchus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e5 (3,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eLeft main broncus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e47 (34,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBleeding \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBronchospasm \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDesaturation\u003c/p\u003e\n \u003cp\u003eBradicardy \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCardiac arrest \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e5(3)\u003c/p\u003e\n \u003cp\u003e8(5)\u003c/p\u003e\n \u003cp\u003e47 (34,9) 2(1,2) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1(0,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eBronchoscopy-Only n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e122 (73,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.68354430379746%\" style=\"width: 80.5474%;\"\u003e\n \u003cp\u003eCT \u0026plusmn; Bronchoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.009041591320072%\" style=\"width: 16.2268%;\"\u003e\n \u003cp\u003e43 (26,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eIQR:Q1-Q3 (n=165)\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe foreign bodies removed from the children are shown in Table 2. According to Table 2, the most common aspirated foreign body in children was peanut 29.2% (n=40), followed by kernel 13.14% (n=18) and needle 11.67% (n=16). 47 patients had positive findings on direct radiography. In 24 patients, aspirated opaque substances (needle, stone, pen tip, metal and tack) could be seen (Figure 1). In 23 patients, although no foreign body was seen in direct graphy, findings such as increased ventilation and atelectasis were observed(Figure 2). In one patient, two needles were observed at the same time, one was aspirated and the other was swallowed. In 2 patients, bronchoscopy was performed twice, one 2 months and one 4 months apart.\u003c/p\u003e\n\u003cp\u003eTable 2. Distribution of removed foreign bodies\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eForeign Body \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePeanut \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40 (29,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSunflower Seed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18 (13,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNeedle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16 (11,68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHazelnut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7 (5,11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWalnut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6 (4,38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAlmond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5 (3,65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePumpkin Seeds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5 (3,65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCarrot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4 (2,92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4 (2,92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWatermelon Seeds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3 (2,19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSweetcorn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3 (2,19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGround Peanut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3 (2,19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2 (1,46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePiece Of Meat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2 (1,46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePen Tip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2 (1,46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHaricot Bean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2 (1,46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePotatoes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2 (1,46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBroad Beans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBulgur Wheat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eApple\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCashew\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePen Cap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChestnut\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRoasted Chickpea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMetal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNylon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChickpeas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFastener\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLentils \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRosary Bead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1 (0,73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe presence of a foreign body detected by bronchoscopy was considered as the gold standard and the predictive values of CT and X-ray devices in detecting foreign bodies and their compatibility with each other were investigated (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eCompatibility and performance of CT and X-ray devices with bronchoscopy being the gold standard for detecting FBA\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"701\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.827389443651924%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBronchoscopy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.037037037037036%\"\u003e\n \u003cp\u003eFBA + (n=135)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.493827160493828%\"\u003e\n \u003cp\u003eFBA - (n=30)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.117283950617283%\"\u003e\n \u003cp\u003eTotal (n=165)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.728395061728396%\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.728395061728396%\"\u003e\n \u003cp\u003eSpesificity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.728395061728396%\"\u003e\n \u003cp\u003eAccuracy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.37037037037037%\"\u003e\n \u003cp\u003ek\u0026nbsp;(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.796296296296296%\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.126961483594865%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.70042796005706%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e%100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e%100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e%100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e1 (1-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\"\u003e\n \u003cp\u003eFBA +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.126961483594865%\"\u003e\n \u003cp\u003e40 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.70042796005706%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e40 (93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\"\u003e\n \u003cp\u003eFBA -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.126961483594865%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.70042796005706%\"\u003e\n \u003cp\u003e3 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e3(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\"\u003e\n \u003cp\u003e\u003cstrong\u003eX-ray\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.126961483594865%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.70042796005706%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e%34,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e%96,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e%45,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e0,144 (0,10-0,26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\"\u003e\n \u003cp\u003eFBA +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.126961483594865%\"\u003e\n \u003cp\u003e46 (34,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.70042796005706%\"\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e47 (28,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.560627674750356%\"\u003e\n \u003cp\u003eFBA -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.126961483594865%\"\u003e\n \u003cp\u003e89 (65,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.70042796005706%\"\u003e\n \u003cp\u003e29 (96,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.125534950071327%\"\u003e\n \u003cp\u003e117 (71,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.841654778887303%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.830242510699%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.131241084165477%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCI: confidence İnterval,\u0026nbsp;\u003c/em\u003e\u003cem\u003ek\u003c/em\u003e\u003cem\u003e:Kappa\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe sensitivity and specificity values of the CT for detecting the presence of foreign body were 100%, 100% and 100%, respectively, and the total accuracy rate was (40+3)/43=100%. The compatibility of the CT with the bronchoscopy was determined to be at a statistically significant 1 (95% CI:1-1;p\u0026lt;0.001) substantial agreement level. When the results were analysed, it was determined that the sensitivity of the X-Ray device in detecting the presence of foreign body was 34.1%, the specificity was 96.7%, and the total accuracy was (46+29)/165=45.4%. The agreement between CT with the bronchoscopy device was at a statistically significant 0.144 (95% CI: 0.10-0.26;p=0.001) at slight agreement level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe agreement between X-RAY and CT devices used to detect the presence of foreign bodies in children was analysed (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Compatibility of CT and X-ray devices\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFBA + (n=40)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFBA - (n=3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal (n=43)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ek\u0026nbsp;(95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eX-ray\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0,06 (0,01-0,28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0,237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePozitif\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (32,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (30,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNegatif\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27 (67,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30 (69,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eCI: confidence İnterval,\u0026nbsp;\u003c/em\u003e\u003cem\u003ek\u003c/em\u003e\u003cem\u003e:Kappa\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAccording to table 4, it was determined that the compatibility between X-RAY and CT devices was not statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Comparing groups in terms of FBA diagnosis\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.033112582781456%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003eGroup I (n=122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003eGroup II (n=43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.198675496688743%\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.033112582781456%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.198675496688743%\" valign=\"top\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.033112582781456%\" valign=\"top\"\u003e\n \u003cp\u003eFBA +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003e95 (77,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003e40 (93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.198675496688743%\" valign=\"top\"\u003e\n \u003cp\u003e135 (81,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.033112582781456%\" valign=\"top\"\u003e\n \u003cp\u003eFBA -\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003e27 (22,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.52980132450331%\" valign=\"top\"\u003e\n \u003cp\u003e3 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.198675496688743%\" valign=\"top\"\u003e\n \u003cp\u003e30 (18,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.70860927152318%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eGroup I: Bronchoscopy-Only, Group II: CT \u0026plusmn; Bronchoscopy, p value was obtained from Pearson Chi Square test.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIt was determined that there were statistically significant differences between groups in detecting FBA (p=0.027). In Group II (CT \u0026plusmn; Bronchoscopy), the detection rate of FBA was 93%, whereas in Group I (only Bronchoscopy), it was significantly higher at 77.9% compared to 77.9%.(Fig\u0026uuml;re 3) Additionally, it was observed that the negative diagnosis rate in Group II was significantly higher compared to Group I (Table 5).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eForeign body aspiration in children is a potentially serious household accident that is a frequent presenting complaint to paediatric emergency departments [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. More than 80% of foreign body aspiration cases occur in early childhood and the highest incidence is observed between 10 and 24 months. The absence of molars and premolars and the tendency to bring all objects to the mouth explain the special predisposition of children in this age group [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Symptoms may vary significantly according to the location of the foreign body in the airways. When the foreign body is trapped in the larynx or trachea, respiratory distress or stridor immediately suggests the diagnosis. However, in the vast majority of cases (75 to 94 per cent) the foreign body migrates into the bronchi and clinical symptoms are much less persistent.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Since the risk of complications related to the presence of a bronchial foreign body increases with the passage of time, it is important to make the diagnosis as soon as possible (3). Currently, the standard technique for the treatment of foreign body aspiration in children is rigid bronchoscopy under general anaesthesia, but this technique is used very frequently for both diagnostic and therapeutic purposes, resulting in a negative bronchoscopy rate of 10\u0026ndash;61%.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Most authors have stated that rigid bronchoscopy is the standard technique for the removal of bronchial foreign bodies in children with a success rate of more than 97% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In our study, rigid bronchoscopy was negative in 30 patients among 165 patients. The rate of negative rigid bronchoscopy was 18.1%. All of these patients were in the non-CT patient population.\u003c/p\u003e \u003cp\u003eAccording to various authors, the complication rate related to rigid bronchoscopy varies between 2% and 22%. The most common complications are laryngeal oedema and pneumothorax, but more serious complications such as tracheal tear, bronchial tear, hypoxia and cardiorespiratory arrest may also occur. Fortunately, these complications are rare.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Because of these rare but serious complications, it is important to reduce the rate of negative rigid bronchoscopy[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The skills and clinical experience of the surgeon and anaesthetist are also very important for the bronchoscopy procedure. Anaesthetists and surgeons should be aware of the severity of complications and have a plan to manage postoperative complications [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our patients, intra-bronchial haemorrhage occurred in 5 patients, low oxygen saturation and bronchospasm in 8 patients, bradycardia in 2 patients and cardiac arrest in 1 patient who returned to sinus rhythm with cardiac massage. No bronchoscopy-related mortality was observed in our patients.\u003c/p\u003e \u003cp\u003eAccording to Silva et al., the sensitivity and specificity of chest radiography increases when chest radiography is performed 24 hours after aspiration [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In the acute phase, the sensitivity and specificity of chest radiography for the diagnosis of bronchial foreign body is low[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and it is reported to be normal in 14 to 37% of cases in many studie [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In our study, 46(34.1%) of 135 patients who had detected FBA on bronchoscopy had positive findings on DG. In 89 (65.9%) patients in whom FBA was detected in bronchoscopy, no finding in favour of FBA was observed on direct radiography.\u003c/p\u003e \u003cp\u003eHegde et al. reported that CT was superior to plain films in the detection of foreign bodies in the respiratory tract[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Behera et al. evaluated patients who underwent CT and bronchoscopy for FBA and found that 59/60 of them were confirmed. The remaining case, which was suspicious on CT, was found to be a thick mucus plug by rigid bronchoscopy [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Gibbons et al. compared 64 patients who underwent bronchoscopy only with 69 patients who underwent CT and bronchoscopy and reported that the diagnosis of foreign body was excluded in 49 patients with CT and unnecessary bronchoscopy was prevented [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In our study, 165 paediatric patients who underwent bronchoscopy were evaluated and no foreign body was observed in 30 patients. In a group of 122 patients who underwent bronchoscopy alone, no foreign body was observed in 27 patients (22%), whereas in a group of 43 patients who underwent CT, no foreign body was observed in bronchoscopy performed because of the anamnesis and intense dyspnoea in the patients, although CT was negative in 3 patients (7%). In our study, the rate of negative bronchoscopy decreased from 22\u0026ndash;7% in the CT group compared to the bronchoscopy only group.\u003c/p\u003e \u003cp\u003eQiu et al., in a 7-year study evaluating 48 patients who aspirated FB and had false negativity on CT, stated that 43.9% of the aspirated material consisted of sheet or dust. It was also stated that in more than 50% of the patients, the diagnosis was made at least 2 weeks later, and it took up to 2 years at the longest. It has also been stated that the image may be confused with pneumonia due to lung infiltrates in these patients [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In our study, the application period of the patients was between the same day and one month, and the number of patients with lung infiltration was only 2 (1.2%).\u003c/p\u003e \u003cp\u003eKim et al stated in their study that: In addition to the use of CT preventing unnecessary bronchoscopies, the use of CT for diagnosis in suspicious cases can potentially prevent missed diagnosis in clinically suspicious cases, which can occur in up to 20% of cases with plain films [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. \u0026Ccedil;ift\u0026ccedil;i et al. stated that up to 33% of FBA cases can be misdiagnosed as pneumonia based on clinical findings alone[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In our study, it was observed that 2 of 3 patients with negative FB on bronchoscopy had an asthma attack and one patient had pneumonia. Another potential benefit of using CT to diagnose FB is its applicability for triage in public hospitals where a pediatric surgeon is not available. In these hospitals, unnecessary transfer to the referral hospital can be prevented in case of CT negativity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In our study, 12 patients first applied to an external center and were referred to us upon detection of FB on CT.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePositive clinical diagnosis of FBA is often difficult because of the low sensitivity and specificity of penetration syndrome and pulmonary auscultation. Therefore, complementary radiological examinations play an important role in reducing the rate of negative rigid bronchoscopy in children with suspected bronchial foreign bodies. Rigid bronchoscopy should always be performed as a first-line procedure in the presence of a radiopaque, obstructive foreign body on chest radiography or in the presence of characteristic clinical and radiographic signs. In doubtful cases, the presence of a foreign body should be confirmed by CT. Low-dose chest CT is a highly effective imaging modality with high sensitivity and specificity for the diagnosis of FBA in children. Since it can be performed rapidly with minimal radiation exposure and can prevent unnecessary bronchoscopies, it should be used in suspicious cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e The study was approved by the Hatay Mustafa Kemal University, Faculty of Medicine and carried out according to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e All authors consent for manuscript submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performedby M.E.\u0026Ccedil;., \u0026Ccedil;.E., İ.K. Data analysis was performed by M.E.\u0026Ccedil;., M.K., A.A. Manuscript writing and review were performed by M.E.\u0026Ccedil;., B.A., İ.K. All authors approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFasseeh NA, Elagamy OA, Gaafar AH, Reyad HM (2021) A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a retrospective cohort study. 47(1):194\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim IA, Shapiro N, Bhattacharyya N (2015) The national cost burden of bronchial foreign body aspiration in children. Laryngoscope 125(5):1221\u0026ndash;1224\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHitter A, Hullo E, Durand C, Righini CA (2011) Diagnostic value of various investigations in children with suspected foreign body aspiration: review. 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Seminars in Ultrasound, CT and MRI. ;36:8\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1053/j.sult.2014.10.001\u003c/span\u003e\u003cspan address=\"10.1053/j.sult.2014.10.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehera G, Tripathy N, Maru YK et al (2014) Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree. J Laryngology Otology 128:1078\u0026ndash;1083. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S0022215114002837\u003c/span\u003e\u003cspan address=\"10.1017/S0022215114002837\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu W, Wu L, Chen Z (2019) Foreign body aspiration in children with negative multi-detector Computed Tomography results: Own experience during 2011\u0026ndash;2018. Int J Pediatr Otorhinolaryngol 124:90\u0026ndash;93\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Foreign body aspiration, Negative bronchoscopy, Low-dose computed tomography","lastPublishedDoi":"10.21203/rs.3.rs-4522740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4522740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Foreign body aspiration(FBA) remains an important cause of morbidity and mortality in childhood. Unfortunately, the clinical picture is often unclear and the clinician must decide which patients should undergo bronchoscopic evaluation. The aim of this study was to analyse patients who underwent bronchoscopy for suspected foreign body aspiration and to evaluate the properties of computed tomography(CT) in preventing unnecessary bronchoscopy, which carries the risk of serious complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eAll patients younger than 18 years of age who were evaluated for foreign body aspiration at a tertiary children's hospital between June 2014 and February 2023 were included in the retrospective review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eA total of 165 children who underwent bronchoscopy were included in this study. 59.4% (n=98) of the cases were girls and 40.6% (n=67) were boys. The median age of the cases was 2 years, ranging from 0.5 to 18 years, and the interquartile range (Q3-Q1) value was 2. X-ray was performed in 100% of the cases (n=165) and CT scan was performed in 26.1% (n=43). In Group II (CT ± Bronchoscopy), the detection rate of FBA was 93%, whereas in Group I (only Bronchoscopy), it was significantly higher at 77.9% compared to 77.9%. Additionally, the negative diagnosis rate in Group II was significantly higher compared to Group I\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Low-dose chest CT is a highly effective imaging modality with high sensitivity and specificity for the diagnosis of FBA in children. Since it can be performed rapidly with minimal radiation exposure and can prevent unnecessary bronchoscopies in suspicious cases.\u003c/p\u003e","manuscriptTitle":"Negative bronchoscopy or computed tomography radiation in children with suspected foreign body aspiration? Pros and cons","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 16:18:29","doi":"10.21203/rs.3.rs-4522740/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2b03aaf6-1c05-47a9-a444-edcac7548659","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-16T11:45:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-20 16:18:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4522740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4522740","identity":"rs-4522740","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}