تقييم الاستراتيجية المّتبعة في تدبير حالات الاشتباه باستنشاق اجسام اجنبية

Background& Objective: The cases of foreign body aspiration constitute a significant proportion of emergency cases that present to emergency departments around the clock. These cases demand quick management and wisdom to decide the therapeutic procedure, in order to achieve a delicate balance between the need for endoscopy on the one hand and the complications due to endoscopy or the delay of it on the other hand. The possibility of reaching an algorithm based on a combinatorial approach that encompasses evaluation of clinical findings along with investigations will help to increase the accuracy of decision making process and reduce complications. To outline helpful measures in the management of suspected cases of foreign-body aspirations in order to increase the accuracy of bronchoscopy indications, and thus decrease negative bronchoscopies and also reduce morbidity and mortality associated with suspected aspiration’s cases. Materials & Methods: This study was based on reviewing the data of all patients (n= 108 patients) who underwent bronchoscopy under general anesthesia in the ENT emergency at Al-Muwasat Hospital in the period between April and November of 2009. The data included the patient’s age, sex, history, direct observation, radiology and auscultation findings, type and location of the foreign body, complications and the time interval between the aspiration or the onset of symptoms and the time of bronchoscopy. This was a retrospective study. We used Fisher’s exact test to evaluate the data and a P value < 0.0001 to decide if the difference was statistically significant. Results: The patients were categorized in two main groups; the first included the cases with positive history (85 patients), whereas the second included the cases without obvious history of aspiration (23 patients). The cases of metal pin were isolated in a special category in some aspects of the study. A foreign body can be found in 80% of patients of the first group (i.e., positive history), and in 56.6% of the patients in the second group. The presence of radiological changes that could be identified at 51% of the patients was accompanied with positive findings in 94% of conducted bronchoscopies. This positive percentage was lower to 48.9% in patients who had no radiological changes. Physical examination revealed the presence of auscultation changes in 60% of patients, and the bronchoscopy was positive at 83% of those patients. Absence of the auscultation changes lowered the percentage of positive bronchoscopies to 56%. In contrary, the percentage of positive bronchoscopies was lowered to 20% in the absence of both radiological and auscultation changes (4 of 20 patients). Conclusion: Our findings clearly show that positive history plays an important role in increasing the positivity of bronchoscopy. According to our results, it is not advisable to rely solely on radiologic findings or auscultation findings alone in decreasing the doubt/uncertainty when investigating the presence of a foreign body in the bronchi. A management plan that is based on a combinatorial approach of history taking, direct observation to determine the respiratory status of the patient, and radiology and auscultation findings represents the most effective approach to deal with suspected cases of foreign body aspiration.