Changes in the global burden of foreign body aspiration among under-5 children from 1990 to 2019

Economic burden analysis of pediatric tracheobronchial foreign body

Objectives

Tracheobronchial foreign body aspiration (TFBA) constitutes a life-threatening pediatric emergency with substantial clinical and public health implications. While current research prioritizes diagnostic and therapeutic strategies for TFBA, limited attention has been paid to its socioeconomic consequences. This study focuses on Gansu Province, a representative underdeveloped region in China, to systematically assess both direct medical costs (surgical interventions and hospitalization) and broader socioeconomic impacts of pediatric TFBA management. The findings aim to inform evidence-based healthcare policies for childhood emergencies in resource-limited settings.

Methods

Using Gansu Provincial statistical data, we analyzed the economic burden of 951 pediatric tracheobronchial foreign body cases (2017-2021) meeting inclusion criteria at a provincial tertiary hospital's respiratory department.

Results

(1) Urban-rural disparities in economic burden: The average annual total income of rural households was significantly lower than that of urban households (p < 0.01). The proportion of hospitalization costs relative to income in rural areas reached 36.31 ± 4.43%, 3.1 times that of urban households (11.91 ± 2.14%, p < 0.001). Rural minority-concentrated regions bore the heaviest burden (48.06%), while urban Han-majority regions had the lowest burden (9.29%). No significant urban-rural difference in surgical costs (P>0.05). (2) Regional heterogeneity in economic burden: Hospitalization costs in underdeveloped minority-concentrated rural areas reached 13,323¥ (8% higher than the rural average), yet their income (27,678¥) was 33% below the average. Their cost-to-income ratio (48.06%) was 3.2 times that of their urban counterparts (15.21%). In developed Han-majority regions, despite comparable hospitalization costs (11,872 ¥ vs. 12,339 ¥), the higher income (42% above average) resulted in the lowest cost-to-income ratio (21.52%).

Conclusion

TFBA poses a critical global health challenge with disproportionate impacts on children aged 1-3 years and significant economic burden on families, especially in underdeveloped minority-concentrated rural areas. This study highlights severe urban-rural disparities in economic burdens.

Essential Equipment for Baseline Otolaryngology-Head and Neck Surgery Care: A Global Cross-Sectional Survey

Objective

Availability of surgical equipment and access to essential clinical services remains an important barrier to surgical care delivery, particularly in low- and middle-income countries (LMICs). This study aims to characterize the relative availability of essential equipment for otolaryngology-head and neck surgery (OHNS) care across World Bank income groups.

Methods

We conducted a cross-sectional survey on otolaryngologists' perceptions on the availability of surgical equipment and ancillary services in their respective practice settings per a 5-point Likert scale ranging from never to always available. The study was disseminated online via professional societies, personal contacts, and social media. Eligible participants included otolaryngologists from 194 WHO-recognized countries, which were grouped by World Bank income group classification and WHO region.

Results

The study involved 146 otolaryngologists, 69 (47%) from high-income countries (HICs), and 77 (53%) from LMICs. LMIC respondents were predominantly from the African and South-East Asian regions, which comprised 48% and 7.8% of all LMIC respondents, respectively. Results revealed significant differences in the availability of otologic, rhinologic, and endoscopic airway equipment between HICs and LMICs. Differences existed among commonly used equipment such as tympanomastoidectomy equipment and rigid bronchoscopy, to subspecialized equipment such as functional endoscopic sinus surgery equipment and cochlear implants (p < 0.05 each).

Conclusions

The study highlighted key disparities in the availability of essential equipment for baseline OHNS care, especially for pediatric airway and otologic conditions. These results can be used to guide investment and advocacy efforts to improve specialty-specific surgical infrastructure relative to the global burden of OHNS diseases in low-resource settings.

Level of Evidence

3.

Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis

The removal of foreign bodies (FBs) from the airways of children is a critical procedure that can avert serious complications. While both flexible and rigid bronchoscopy techniques are employed for this purpose, their comparative efficacy and safety remain subjects of debate. Therefore, we conducted this investigation to compare between both procedures. Studies comparing flexible to rigid bronchoscopy (n = 14) were identified by searching PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. We performed comparative meta-analyses of reported presentation characteristics and clinical outcomes, using fixed- and random-effects models. A diverse range of FB types and locations were identified. No difference was observed in the success rate of FB removal between flexible and rigid bronchoscopy (logOR = 0.27; 95%CI: -1.91:2.45). The rate of negative first bronchoscopy was higher in the flexible compared to the rigid group (logOR = 2.68; 95%CI: 1.68:3.67). Conversion rates to the alternative method were higher in the flexible bronchoscopy group. The overall complication rates were similar between both methods; however, the risk of desaturation was significantly lower with flexible bronchoscopy (logOR = -2.22; 95%CI: -3.36:-1.08). Flexible bronchoscopy was associated with a shorter length of hospital stay. The choice of bronchoscopy technique should be tailored to individual case characteristics.

Determinants of positive rigid bronchoscopy for suspected organic foreign body aspiration in children younger than five years

Purpose

Rigid bronchoscopy is widely used for diagnosis and treatment of foreign body aspiration (FBA) in children, but negative results can be reported, especially with radiolucent organic FBA. This study aimed to evaluate the clinical features and pre-procedure predictors of organic FBA in children under 5 years of age.

Methods

Children aged less than 5 years old who underwent rigid bronchoscopy for suspected organic FBA were retrospectively evaluated for demographics, history of aspiration, relevant clinical symptoms and signs, radiological findings, in addition to type and location of foreign body (FB). To determine the predictors of positive FBA, stepwise backward logistic regression was applied.

Results

A total of 228 children were included (69.7% boys). The mean age was 1.98 ± 1.07 years. Foreign bodies were found in 202 cases (88.59%). Age ≤ 3 years and history of witnessed choking had the highest sensitivity while diminished breath sounds had the highest specificity for diagnosing FBA. In multivariate analysis, witnessed choking, wheezy chest, diminished breath sounds, and respiratory distress were independently associated with increased risk of FBA.

Conclusion

Children under 5 years of age with suspected organic FBA have varied clinical and radiological findings. The history of choking, wheezy chest, diminished air entry, or respiratory distress increases the chance of positive rigid bronchoscopy in this age group.

Artificial intelligence in the detection of non-biological materials

Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.

The global, regional, and national burden of foreign bodies from 1990 to 2019: a systematic analysis of the global burden of disease study 2019

BACKGROUND

Foreign bodies (FBs) are a common emergency in medical institutions, that can occur in any area and among people of any age, which are common public health problems. Understanding the epidemiological characteristics of FBs is crucial for their prevention and control. The purpose of this study was to analyze the epidemiological characteristics of FBs worldwide through the data from the Global Burden of Disease Study 2019 (GBD 2019).

METHODS

We obtained data from the GBD 2019, which is an important public database to understand the disease burden of FBs. Joinpoint was used to analyze temporal trends in the incidence and death trends of FBs, which is widely used to study the long-term temporal trend of the burden of diseases. SaTScan was used to detect spatial-temporal clusters of pulmonary aspiration and foreign body in the airway (PAFBA), which is based on a Poisson model, scanning the number of people and diseases in the study area to obtain the spatial-temporal clusters of diseases.

RESULTS

Globally, the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) of FBs in 2019 were 869.23/100,000 (679.92/100,000-1120.69/100,000) and 1.55/100,000 (1.41/100,000-1.67/100,000), respectively. The ASIR and ASDR showed downtrends with average annual percent changes (AAPCs) of -0.31% and - 1.47% from 1990 to 2019. Of note, the ASIR showed an uptrend during 2010-2019, especially in high, high-middle, and middle SDI regions. Stratified analysis by age group showed that ASIR increased in each age group in recent years. From 1990 to 2019, the ASDR in the over-70 age group showed an uptrend worldwide, especially in high and high-middle SDI regions. In different types of FBs, the ASDR of PAFBA was the highest. The death burden of PAFBA was mainly clustered in 82 countries during 1993-2007, such as Canada, Cuba, and Mexico.

CONCLUSION

The most important goal is to improve public awareness and emergency knowledge of FBs through publicity methods, such as the internet or offline activities, and to improve laws and regulations. Additionally, different age groups need different targeted measures, such as strengthening the care of children, caring for elderly individuals, improving necessary monitoring programs and reporting systems, conducting effective hazard assessments, and publicity and education activities.