Derivation of a clinical-radiological scoring system to predict foreign body aspiration in children

Table 1 Association of clinical history, examination findings, and radiologic features between children with foreign body recovery during bronchoscopy (positive) and those without foreign body aspiration (negative) by univariate logistic regression analysis, n (%)

Variable	FBA-negative, n = 93	FBA-positive, n = 181	Unadjusted OR (95%CI)	P value
Clinical history
Definitive history of choking	43 (46)	135 (75)	3.38 (2.00-5.72)	< 0.001
Cough	78 (84)	143 (79)	0.74 (0.38-1.41)	0.356
Noisy breathing/stridor	12 (13)	32 (18)	1.42 (0.70-2.87)	0.333
Respiratory distress	81 (87)	131 (72)	0.40 (0.20-0.79)	0.008
Wheeze	26 (28)	15 (8)	0.24 (0.12-0.47)	< 0.001
Absence of concurrent URI	28 (30)	131 (72)	5.98 (3.46-10.34)	< 0.001
No prior history of reactive airway disease	56 (60)	163 (90)	5.87 (3.11-11.05)	< 0.001
Examination findings
Unilateral decreased air entry/wheeze	44 (47)	126 (70)	2.54 (1.52-4.24)	< 0.001
Stridor	3 (3)	10 (6)	1.58 (0.46-5.45)	0.466
Tachypnea	74 (80)	105 (58)	0.36 (0.20-0.64)	< 0.001
Crepitations	33 (36)	34 (19)	0.42 (0.24-0.74)	0.003
SpO2 < 90	29 (31)	30 (17)	0.44 (0.25-0.79)	0.006
Radiological findings
Normal chest radiograph	28 (30)	36 (21)	0.61 (0.34-1.07)	0.085
Unilateral hyperinflation	23 (25)	94 (54)	3.52 (2.02-6.13)	< 0.001
Unilateral collapse/consolidation	29 (31)	39 (22)	0.64 (0.36-1.12)	0.116
Bilateral hyperinflation	8 (9)	4 (2)	0.27 (0.08-0.86)	0.027
Infiltrates	26 (28)	30 (17)	0.54 (0.30-0.98)	0.041

CI: Confidence interval; FBA: Foreign body aspiration; OR: Odds ratio; SpO₂: Peripheral oxygen saturation; URI: Upper respiratory tract infection.

Table 2 Multivariate logistic regression model to identify significant predictors and derivation of the weighted risk score for foreign body aspiration

Clinico-radiological variables	Regression coefficient	Adjusted OR (95%CI)	P value	Weight score
Definitive history of choking	0.58	1.79 (0.94-3.41)	0.077	2
Respiratory distress	-0.08	0.92 (0.37-2.31)	0.864	1
Absence of concurrent URI	1.44	4.21 (2.11-8.40)	< 0.001	4
No prior history of reactive airway disease	1.01	2.77 (1.29-5.92)	0.009	3
Unilateral decreased air entry/wheeze	0.86	2.37 (1.25-4.51)	0.008	2
Tachypnea	-0.91	0.40 (0.19-0.87)	0.021	1
Unilateral hyperinflation	1.32	3.73 (1.91-7.31)	< 0.001	4
Total score				17

CI: Confidence interval; OR: Odds ratio; URI: Upper respiratory tract infection.