Evaluation of Foreign Body Aspiration Score (FOBAS) in Children

Background: Foreign Body Aspiration (FBA) is a common medical emergency among young children. The evaluation of a child with a suspected FBA, at the emergency department (ED), varies between physicians, centers, and countries, with different approaches.

Aim: To assess which clinical, laboratory and radiological findings are risk factors for FBA in children. Secondly, to suggest a comprehensive score based on these findings for decision-making in the ED.

Methods: A retrospective study including all patients aged 0-18 years that were admitted to the Soroka University Medical Center, between 2010 and 2020 for suspected FBA. All subjects underwent flexible bronchoscopy and were divided into two groups (with/ without FBA). Clinical, laboratory, and radiology findings were compared between the groups.

Results: 502 children (median age of 21 months, 58.3% males) were included. 183 (36.5%) with FBA and 319 (63.5%) without FBA. Multivariate regression analysis showed that Bedouin origin, exposure to nuts/seeds, unilateral wheezing/ decreased breathing sounds, stridor, and suggestive findings on chest X-ray were statistically significant risk factors for FBA; Odds ratio [95%CI] 2.759[1.504-5.062], 2.134[1.188-3.832], 2.100 [1.191-3.704], 2.932[1.237-6.948] and 6.471[3.658-11.444], respectively. Overall, FOBAS showed a statistically significant risk for FBA with an increased risk of FBA for each additional point of the score; Odds ratio [95%CI] 1.631 [1.392-1.911].

Conclusions: FOBAS is a statistically significant tool to assess risk for the presence of FBA in children. Once prospectively validated, FOBAS can be used for decision-making at the ED.