Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol and Registration
2.2. Search Strategy and Information Sources
2.3. Eligibility Criteria
2.4. Study Selection
2.5. Data Extraction
2.6. Quality of Studies
2.7. Statistical Analyses
3. Results
3.1. Foreign Body Characteristics
3.2. Clinical Presentation and Outcomes
3.3. FBA Cases According to Child Age
3.4. Quality Assessment
4. Discussion
4.1. Public Health Implications and Practical Recommendations
4.2. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
- Brkic, F.; Umihanic, S.; Altumbabic, H.; Ramas, A.; Salkic, A.; Umihanic, S.; Mujic, M.; Softic, L.; Zulcic, S. Death as a Consequence of Foreign Body Aspiration in Children. Med. Arch. 2018, 72, 220. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Preventing Injuries and Violence: A Guide for Ministries of Health; WHO: Geneva, Switzerland, 2007. [Google Scholar]
- Peden, M.; McGee, K.; Sharma, G. The Injury Chart Book: A Graphical Overview of the Global Burden of Injuries; WHO: Geneva, Switzerland, 2002. [Google Scholar]
- Lorenzoni, G.; Hochdorn, A.; Beltrame Vriz, G.; Francavilla, A.; Valentini, R.; Baldas, S.; Cuestas, G.; Rodriguez, H.; Gulati, A.; van As, A.S. Regulatory and Educational Initiatives to Prevent Food Choking Injuries in Children: An Overview of the Current Approaches. Front. Public Health 2022, 10, 830876. [Google Scholar] [CrossRef] [PubMed]
- Slapak, I.; Passali, F.M.; Gulati, A.; Susy Safe Working Group. Non Food Foreign Body Injuries. Int. J. Pediatr. Otorhinolaryngol. 2012, 76, S26–S32. [Google Scholar] [CrossRef] [PubMed]
- Snidero, S.; Soriani, N.; Baldi, I.; Zobec, F.; Berchialla, P.; Gregori, D. Scale-up Approach in CATI Surveys for Estimating the Number of Foreign Body Injuries in the Aero-Digestive Tract in Children. Int. J. Environ. Res. Public Health 2012, 9, 4056–4067. [Google Scholar] [CrossRef] [PubMed]
- Gardner, H.G.; Baum, C.; Dowd, M.D.; Durbin, D. Policy Statement—Prevention of Choking among Children. Pediatrics 2010, 125, 601–607. [Google Scholar]
- Qureshi, S.; Mink, R. Aspiration of Fruit Gel Snacks. Pediatrics 2003, 111, 687–689. [Google Scholar] [CrossRef] [PubMed]
- Goh, P.L.; Lim, E.H.; Teo, D.S.H.M.; Sairin, M.E. Challenges in Diagnosing Foreign Body Aspiration in Children. Cureus 2022, 14, e21519. [Google Scholar] [PubMed]
- Rance, A.; Mittaine, M.; Michelet, M.; Blondel, A.M.; Labouret, G. Delayed Diagnosis of Foreign Body Aspiration in Children. Arch. Pédiatrie 2022, 29, 424–428. [Google Scholar] [CrossRef] [PubMed]
- Zhu, Y.; Fan, Q.; Cheng, L.; Chen, B. Diagnostic Errors in Initial Misdiagnosis of Foreign Body Aspiration in Children: A Retrospective Observational Study in a Tertiary Care Hospital in China. Front. Pediatr. 2021, 9, 694211. [Google Scholar] [CrossRef] [PubMed]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, 71. [Google Scholar] [CrossRef] [PubMed]
- Moola, S.; Munn, Z.; Tufanaru, C.; Aromataris, E.; Sears, K.; Sfetcu, R.; Currie, M.; Qureshi, R.; Mattis, P.; Lisy, K. Chapter 7: Systematic Reviews of Etiology and Risk. In Joanna Briggs Institute Reviewer’s Manual; The Joanna Briggs Institute: Adelaide, Australia, 2017; Volume 5, pp. 217–269. [Google Scholar]
- Munn, Z.; Barker, T.H.; Moola, S.; Tufanaru, C.; Stern, C.; McArthur, A.; Stephenson, M.; Aromataris, E. Methodological Quality of Case Series Studies: An Introduction to the JBI Critical Appraisal Tool. JBI Evid. Synth. 2020, 18, 2127–2133. [Google Scholar] [CrossRef] [PubMed]
- Canadian Pediatric Society. Preventing Choking and Suffocation in Children; Canadian Pediatric Society: Ottawa, ON, Canada, 2020. [Google Scholar]
- Chang, D.T.; Abdo, K.; Bhatt, J.M.; Huoh, K.C.; Pham, N.S.; Ahuja, G.S. Persistence of Choking Injuries in Children. Int. J. Pediatr. Otorhinolaryngol. 2021, 144, 110685. [Google Scholar] [CrossRef] [PubMed]
- West, B.A.; Rudd, R.A.; Sauber-Schatz, E.K.; Ballesteros, M.F. Unintentional Injury Deaths in Children and Youth, 2010–2019. J. Saf. Res. 2021, 78, 322–330. [Google Scholar] [CrossRef] [PubMed]
- Rose, D.; Dubensky, L. Airway Foreign Bodies; StatPearls: Treasure Island, FL, USA, 2019. [Google Scholar]
- Litovitz, T.; Whitaker, N.; Clark, L. Preventing Battery Ingestions: An Analysis of 8648 Cases. Pediatrics 2010, 125, 1178–1183. [Google Scholar] [CrossRef] [PubMed]
- Völker, J.; Völker, C.; Schendzielorz, P.; Schraven, S.P.; Radeloff, A.; Mlynski, R.; Hagen, R.; Rak, K. Pathophysiology of Esophageal Impairment Due to Button Battery Ingestion. Int. J. Pediatr. Otorhinolaryngol. 2017, 100, 77–85. [Google Scholar] [CrossRef] [PubMed]
- Sethia, R.; Gibbs, H.; Jacobs, I.N.; Reilly, J.S.; Rhoades, K.; Jatana, K.R. Current Management of Button Battery Injuries. Laryngoscope Investig. Otolaryngol. 2021, 6, 549–563. [Google Scholar] [CrossRef]
- Park, S.-J.; Burns, H. Button Battery Injury. Aust. J. Gen. Pract. 2022, 51, 471–475. [Google Scholar] [CrossRef] [PubMed]
- Voelker, J.; Voelker, C.; Engert, J.; Schendzielorz, P.; Hagen, R.; Rak, K. Severe Tracheobronchial Harm Due to Lithium Button Battery Aspiration: An in Vitro Study of the Pathomechanism and Injury Pattern. Int. J. Pediatr. Otorhinolaryngol. 2020, 139, 110431. [Google Scholar] [CrossRef] [PubMed]
- Fano, C.; Lorenzoni, G.; Azzolina, D.; Giuliani, A.; French, M.; Campagna, S.; Berchialla, P.; Gregori, D. Perception of Choking Injury Risk among Healthcare Students. J. Community Health 2019, 44, 974–981. [Google Scholar] [CrossRef] [PubMed]
- Nissen, T.; Wynn, R. The Clinical Case Report: A Review of Its Merits and Limitations. BMC Res. Notes 2014, 7, 264. [Google Scholar] [CrossRef] [PubMed]
Characteristics | N | N = 294 |
---|---|---|
Gender | 294 | |
F | 100 (34%) | |
M | 194 (66%) | |
Age | 294 | 3.5 (1.0, 8.0) |
Country | 294 | |
Africa | 14 (4.8%) | |
America | 90 (31%) | |
Asia | 126 (43%) | |
Australia | 7 (2.4%) | |
Europe | 57 (19%) | |
Foreign body characteristics | ||
Shape | 294 | |
Round | 48 (16%) | |
Cone | 13 (4.4%) | |
Cylindrical | 40 (14%) | |
Elongated | 40 (14%) | |
Irregular | 45 (15%) | |
Oval | 12 (4.1%) | |
Polygon | 13 (4.4%) | |
Sharp | 57 (19%) | |
Spherical | 19 (6.5%) | |
Spiral | 7 (2.4%) | |
Length | 141 | 2.00 (1.40, 3.20) |
Width | 68 | 0.80 (0.50, 1.00) |
Diameter | 59 | 0.80 (0.50, 1.05) |
Color | 254 | |
Black | 24 (9.4%) | |
Blue | 12 (4.7%) | |
Brown | 18 (7.1%) | |
Gold | 4 (1.6%) | |
Green | 16 (6.3%) | |
Grey | 95 (37%) | |
Multicolor | 6 (2.4%) | |
Orange | 2 (0.8%) | |
Pink | 5 (2.0%) | |
Red | 15 (5.9%) | |
Transparent | 22 (8.7%) | |
White | 21 (8.3%) | |
Yellow | 14 (5.5%) | |
Clinical presentation | ||
Location | 294 | |
Bronchus | 102 (35%) | |
Larynx | 68 (23%) | |
Lungs | 27 (9.2%) | |
Nasal cavity | 25 (8.5%) | |
Pharynx | 35 (12%) | |
Trachea | 37 (13%) | |
Choking | 294 | |
No | 217 (74%) | |
Yes | 77 (26%) | |
Cough | 294 | |
No | 113 (38%) | |
Yes | 181 (62%) | |
Wheezing/stridor | 294 | |
No | 167 (57%) | |
Yes | 127 (43%) | |
Respiratory distress | 294 | |
No | 134 (46%) | |
Yes | 160 (54%) | |
Fever | 294 | |
No | 238 (81%) | |
Yes | 56 (19%) | |
Cyanosis | 294 | |
No | 230 (78%) | |
Yes | 64 (22%) | |
Pain | 294 | |
No | 220 (75%) | |
Yes | 74 (25%) | |
Vomit | 294 | |
No | 269 (91%) | |
Yes | 25 (8.5%) | |
Cardiorespiratory arrest | 294 | |
No | 286 (97%) | |
Yes | 8 (2.7%) | |
Asymptomatic | 294 | |
No | 265 (90%) | |
Yes | 29 (9.9%) | |
Outcomes | ||
Death | 294 | |
No | 281 (96%) | |
Yes | 13 (4.4%) | |
Complications | 294 | |
No | 223 (76%) | |
Yes | 71 (24%) |
Characteristic | N | ≤1, N = 94 | >1, N = 200 | p-Value |
---|---|---|---|---|
Gender | 294 | 0.3 | ||
F | 36 (38%) | 64 (32%) | ||
M | 58 (62%) | 136 (68%) | ||
Country | 294 | 0.5 | ||
Africa | 2 (2.1%) | 12 (6.0%) | ||
America | 33 (35%) | 57 (28%) | ||
Asia | 37 (39%) | 89 (44%) | ||
Australia | 2 (2.1%) | 5 (2.5%) | ||
Europe | 20 (21%) | 37 (18%) | ||
Foreign body characteristics | ||||
Length | 141 | 2.00 (1.30, 3.65) | 2.10 (1.45, 3.00) | 0.4 |
Width | 68 | 0.90 (0.50, 1.20) | 0.70 (0.50, 1.00) | 0.5 |
Diameter | 59 | 0.60 (0.48, 1.20) | 0.90 (0.50, 1.05) | 0.6 |
Clinical presentation | ||||
Location | 294 | <0.001 | ||
Bronchus | 22 (23%) | 80 (40%) | ||
Larynx | 36 (38%) | 32 (16%) | ||
Lungs | 7 (7.4%) | 20 (10%) | ||
Nose | 0 (0%) | 25 (12%) | ||
Pharynx | 16 (17%) | 19 (9.5%) | ||
Trachea | 13 (14%) | 24 (12%) | ||
Choking | 294 | <0.001 | ||
No | 57 (61%) | 160 (80%) | ||
Yes | 37 (39%) | 40 (20%) | ||
Cough | 294 | 0.4 | ||
No | 33 (35%) | 80 (40%) | ||
Yes | 61 (65%) | 120 (60%) | ||
Wheezing/stridor | 294 | <0.001 | ||
No | 38 (40%) | 129 (64%) | ||
Yes | 56 (60%) | 71 (36%) | ||
Respiratory distress | 294 | <0.001 | ||
No | 28 (30%) | 106 (53%) | ||
Yes | 66 (70%) | 94 (47%) | ||
Fever | 294 | 0.7 | ||
No | 75 (80%) | 163 (82%) | ||
Yes | 19 (20%) | 37 (18%) | ||
Cyanosis | 294 | 0.01 | ||
No | 65 (69%) | 165 (82%) | ||
Yes | 29 (31%) | 35 (18%) | ||
Pain | 294 | 0.016 | ||
No | 62 (66%) | 158 (79%) | ||
Yes | 32 (34%) | 42 (21%) | ||
Vomit | 294 | 0.2 | ||
No | 83 (88%) | 186 (93%) | ||
Yes | 11 (12%) | 14 (7.0%) | ||
Cardiorespiratory arrest | 294 | 0.002 | ||
No | 87 (93%) | 199 (100%) | ||
Yes | 7 (7.4%) | 1 (0.5%) | ||
Asymptomatic | 294 | 0.2 | ||
No | 88 (94%) | 177 (88%) | ||
Yes | 6 (6.4%) | 23 (12%) | ||
Outcomes | ||||
Death | 294 | <0.001 | ||
No | 82 (87%) | 199 (100%) | ||
Yes | 12 (13%) | 1 (0.5%) | ||
Complications | 294 | 0.12 | ||
No | 66 (70%) | 157 (78%) | ||
Yes | 28 (30%) | 43 (22%) |
ROB Case Reports (N 234) | |
---|---|
Were patient’s demographic characteristics clearly described? | |
No | 7 (3.0%) |
Yes | 227 (97%) |
Was the patient’s history clearly described and presented as a timeline? | |
No | 31 (13%) |
Yes | 203 (87%) |
Was the current clinical condition of the patient on presentation described in detail? | |
No | 5 (2.1%) |
Yes | 229 (98%) |
Were diagnostics tests or assessment methods and the results clearly described? | |
No | 12 (5.1%) |
Yes | 222 (95%) |
Was the intervention(s) or treatment procedure(s) clearly described? | |
No | 16 (6.8%) |
Yes | 218 (93%) |
Was the post-intervention clinical condition clearly described? | |
No | 32 (14%) |
Yes | 202 (86%) |
Were adverse events (harms) or unanticipated events identified and described? | |
No | 50 (21%) |
Yes | 184 (79%) |
Does the case report provide takeaway lessons? | |
No | 15 (6.4%) |
Yes | 219 (94%) |
ROB Case series (N 14) | |
Were there clear criteria for inclusion in the case series? | |
No | 1 (7.1%) |
Yes | 13 (93%) |
Was the condition measured in a standard, reliable way for all participants included in the case series? | |
No | 2 (14%) |
Yes | 12 (86%) |
Were valid methods used for identification of the condition for all participants included in the case series? | |
No | 1 (7.1%) |
Yes | 13 (93%) |
Did the case series have consecutive inclusion of participants? | |
No | 2 (14%) |
Yes | 12 (86%) |
Did the case series have complete inclusion of participants? | |
Yes | 14 (100%) |
Was there clear reporting of the demographics of the participants included in the study? | |
No | 4 (29%) |
Yes | 10 (71%) |
Was there clear reporting of clinical information of the participants? | |
No | 1 (7.1%) |
Yes | 13 (93%) |
Were the outcomes or follow-up results of cases clearly reported? | |
No | 3 (21%) |
Yes | 11 (79%) |
Was there clear reporting of the presenting sites’/clinics’ demographic information? | |
No | 4 (29%) |
Yes | 10 (71%) |
Was statistical analysis appropriate? | |
No | 6 (43%) |
Yes | 8 (57%) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Lorenzoni, G.; Vertuani, M.; Basso, V.; Rescigno, P.; Ocagli, H.; Gregori, D. Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature. Children 2023, 10, 1709. https://doi.org/10.3390/children10101709
Lorenzoni G, Vertuani M, Basso V, Rescigno P, Ocagli H, Gregori D. Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature. Children. 2023; 10(10):1709. https://doi.org/10.3390/children10101709
Chicago/Turabian StyleLorenzoni, Giulia, Marco Vertuani, Valeria Basso, Paola Rescigno, Honoria Ocagli, and Dario Gregori. 2023. "Characterization of Non-Food Foreign Bodies Aspirated by Children: A Systematic Review of the Literature" Children 10, no. 10: 1709. https://doi.org/10.3390/children10101709