• Rahul K Shah, Anju Patel, Lina Lander, and Sukgi S Choi.
• Children's National Medical Center, Washington, DC 20010, USA. rshah@cnmc.org
• Arch. Otolaryngol. Head Neck Surg. 2010 Apr 1;136(4):373-9.

ObjectiveTo review national trends in the management of pediatric airway foreign bodies (A-FBs) and esophageal foreign bodies (E-FBs) that obstruct the airway.DesignRetrospective review using a national pediatric data set (Kids' Inpatient Database).SettingPediatric patients admitted across the United States during 2003.PatientsThe Kids' Inpatient Database 2003 samples 2 984 129 pediatric discharges from 3438 hospitals in 36 states.Main Outcome MeasuresThe Kids' Inpatient Database 2003 was analyzed for A-FBs and E-FBs (International Classification of Diseases, Ninth Revision, Clinical Modification codes E911 and E912) in patients 20 years or younger, and weighted data are presented to facilitate national estimates.ResultsA total of 2771 patients (59% male) were admitted for an A-FB or an E-FB that was obstructing the airway. The mean (SE) age of the patients was 3.5 (0.17) years; 55% were younger than 2 years. The foreign bodies were classified as food (42%; mean age, 2.5 years) or other (58%; mean age, 4.3 years). The average length of stay was 6.4 days (median [SE], 1.5 [0.6] days), and the average number of procedures was 2.4 (median [SE], 1.3 [0.1] procedures). Seventy-one percent of the patients were treated at teaching hospitals. The mean (SD) total charges were $34 652 ($3543), with regional variation (P < .001). Children's hospitals (28%) had higher mean total charges than nonchildren's hospitals (P = .03); 3.4% of admissions died in the hospital (mean [SE] age, 4.6 [0.9] years), with an average length of stay of 11.7 (SE, 2.7) days and an average of 6.2 (SE, 0.7) procedures. Bronchoscopy (52%), esophagoscopy (28%), and tracheotomy (1.7%) were the primary procedures performed. The rates of positive FB findings for bronchoscopy and esophagoscopy were 37% and 46%, respectively.ConclusionsPediatric A-FBs and E-FBs that obstruct the airway occur infrequently. Most of the patients are referred to teaching institutions. Among patients who were admitted with a diagnosis of airway obstruction from an A-FB or an E-FB, the rates of positive findings at surgery were 37% and 46%, respectively. A surprisingly high mortality rate was noted. Alternative education measures should be considered to train physicians in the management of this infrequent, potentially lethal condition.

25 keywords...

hide…