The causes and complications of late diagnosis of foreign body aspiration in children. Report of 210 cases.

Late diagnoses of foreign body aspiration were defined as occurring beyond 3 days between the aspiration of the foreign body, or onset of symptoms, and correct diagnosis. We reviewed a total of 210 children with late diagnosis of foreign body aspiration. The causes creating late diagnosis of foreign body aspiration in children were as follows: (1) parental negligence (106/210, 50%); (2) misdiagnosis by the fellow professionals and pediatricians (39/210, 19%); (3) the normal chest roentgenographic findings (29/210, 14%); (4) lack of typical symptoms and signs (26/210, 12%); (5) mismanagement (8/210, 4%); and (6) a negative bronchoscopic finding (2/210, 1%). The most common complications encountered were obstructive emphysema (77/186, 41%), mediastinal shift (63/186, 34%), pneumonia (43/186, 24%), and atelectasis (33/186, 18%) in 186 patients who underwent a chest roentgenographic examination. The incidence of major complications was 64% (48/75) in the children who were diagnosed within 4 to 7 days; however, the complication rate was 70% (39/56) in those with a delay in diagnosis of 15 to 30 days, and 95% (20/21) in the cases with a delay in diagnosis of over 30 days after aspirating the foreign bodies.