2015 HSC Section 1 Book of Articles

Reprinted by permission of Laryngoscope. 2014 Nov 1. doi:10.1002/lary.25002. (Epub ahead of print).

The Laryngoscope V C 2014 The American Laryngological, Rhinological and Otological Society, Inc.

The National Cost Burden of Bronchial Foreign Body Aspiration in Children

Irene A. Kim, MD; Nina Shapiro, MD; Neil Bhattacharyya, MD

Objectives/Hypothesis: Foreign body aspiration (FBA) continues to be a concerning pediatric problem, accounting for thousands of emergency room visits and more than 100 deaths each year in the United States. The costs incurred with hospi- talizations and procedures following these events are the focus of this study. Study Design: Retrospective review. Methods: The Nationwide Inpatient Sample from 2009 to 2011 was analyzed, and all cases with pediatric bronchial for- eign body aspirations (International Classification of Diseases-9 codes: 934.0, 934.1, 934.8, and 934.9) were reviewed. Cases were analyzed to determine type of foreign body aspiration, procedural interventions performed, duration of inpatient stay, mortality rate, complications, and posthospitalization disposition. The median length of hospital stay and total costs associ- ated with aspiration events were determined. Results: An estimated 1,908 6 273 pediatric bronchial FBA patients were admitted annually over the 3-year period (mean age, 3.6 6 0.3 years; 61.3% 6 1.9% male). The ratio of foreign object aspiration to food aspiration was 5:3. Overall, 56%.0 6 3.6% of the patients underwent a bronchoscopic procedure for foreign body removal; of those, 41.5% 6 2.5% had a foreign body removed at the time of the endoscopy. The hospital mortality rate associated with bronchial aspiration was 1.8% 6 0.4%; and 2.2% 6 0.5% of patients were diagnosed with anoxic brain injury. The median length of stay was 3 days (25th–75th interquartile range, 1–7 days).The median charges and actual costs per case were $20,820 ($10,800–$53,453) and $6,720 ($3,628–$16,723), respectively. Conclusion: The annual overall inpatient cost associated with pediatric bronchial foreign-body aspiration is approxi- mately $12.8 million. Combined, the rate of death or anoxic brain injury associated with pediatric foreign body is approxi- mately 4%. Key Words: Foreign body, aspiration, choking, bronchial, national, cost. Level of Evidence: 2C. Laryngoscope , 00:000–000, 2014

INTRODUCTION Foreign body aspiration poses a significant public health issue because it accounts for thousands of emer- gency room visits and more than 100 deaths each year in the United States alone. In fact, according to the Cen- ters for Disease Control and Prevention, pediatric FBA accounted for more than 17,500 emergency room visits in 2001. 1–3 The pediatric population is globally more affected than older patient cohorts by FBA of both food and non- food objects, given the inherent characteristics of this group. Young children are more likely to explore their environment by placing objects into their mouths and unfortunately have underdeveloped swallowing and From the Otolaryngology–Head & Neck Surgery, David Geffen School of Medicine at UCLA ( I . A . K ., N . S .), Los Angeles, California; and the Department of Otology & Laryngology, Harvard Medical School ( N . B .), Boston, Massachusetts, U.S.A Editor’s Note: This Manuscript was accepted for publication October 6, 2014. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Irene A. Kim, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, CHS 62–237, Los Angeles, CA 90095-1624. E-mail: iakim@mednet.ucla.edu

coughing mechanisms. Thus, the majority of patients with FBA are younger than 5 years old. 1 When these patients present to the emergency room with a wit- nessed choking event—or concerning symptoms such as shortness of breath, cough, or wheezing—the patients’ history, clinical examination, and radiographic studies usually prompt the healthcare provider to consult an otolaryngologist who is equipped to perform a bronchos- copy in the operating room. The patients are then typi- cally admitted following these procedures, or for observation if a procedure is not performed. Bronchial FBAs lead to numerous hospital admis- sions and procedures each year, but related hospital charges and costs to the healthcare system have not been objectively delineated previously. The aim of this study was to review and examine FBA cases gathered from the 2009 to 2011 Nationwide Inpatient Sample (NIS) to determine the type of foreign body involved, procedural interventions performed, duration of inpa- tient stay, mortality rate, complications, posthospitaliza- tion disposition, and the overall healthcare costs of FBA in the United States.

MATERIALS AND METHODS The data source for this study consisted of the NIS for the calendar years 2009 to 2011. This study was reviewed by our

DOI: 10.1002/lary.25002

Laryngoscope 00: Month 2014

Kim et al.: Cost of Foreign Body Aspiration in Children

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