Clinical characteristics and factors influencing hospitalization in pediatric patients with foreign body aspiration: a comprehensive analysis in an emergency department

Clinical characteristics and factors influencing hospitalization in pediatric patients with foreign body aspiration: a comprehensive analysis in an emergency department

Foreign body aspiration, Pediatric emergency, Rigid bronchoscopy, Hospitalization, Airway management

Abstract
Background Foreign body aspiration (FBA) in children is a potentially life-threatening event, especially in those
under 3 years of age. This study aimed to identify clinical factors associated with hospitalization in pediatric FBA and
to highlight innovative retrieval methods used in a tertiary care setting.
Methods A retrospective analysis was conducted of pediatric patients (<18 years) presenting with confirmed
airway FBA between January 2015 and September 2023 at Srinagarind Hospital, Khon Kaen University. Demographic
information, clinical characteristics, and procedural data were collected. Univariate and multivariate logistic regression
analyses identified predictors of hospitalization.
Results Among 297 pediatric patients with FBA, 39 (13.1%) required hospitalization. Hospitalized children were
younger (median age: 3 years; interquartile range [IQR] 2–7) compared with non-hospitalized children (median
age: 4 years; IQR 3–7, p=0.018). FBA involving the larynx-trachea-bronchus significantly increased the likelihood of
admission (adjusted odds ratio [AOR]=22.0; 95% confidence interval [CI]: 6.64–72.63; p<0.001). Delayed presentation
to the emergency department more than two hours after onset was also associated with hospitalization (OR=2.77;
95% CI: 1.08–7.09; p=0.033). Although rigid bronchoscopy remained the mainstay treatment, flexible bronchoscopy
was successfully utilized in nine cases. Notably, a novel technique using a 3 mm gold-plated neodymium magnet
under fluoroscopic guidance enabled the safe retrieval of distal metallic foreign bodies. Complete removal of the
aspirated objects was achieved in all patients; however, one patient died following prolonged hypoxia prior to
hospital arrival.
Conclusions Younger age, delayed emergency department presentation, and location of the foreign body in the
larynx-trachea-bronchus are significant predictors of hospitalization in pediatric FBA. Rigid bronchoscopy remains
the primary management strategy, while flexible bronchoscopy and innovative retrieval methods, including

Piyadarat Asawasakulchokedee1

, Rattapon Uppala1* , Phanthila Sitthikarnkha1

, Sirapoom Niamsanit1
,

Leelawadee Techasatian1

, Suchaorn Saengnipanthkul1

and Pornthep Kasemsiri2

2025

Peri Irawan

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