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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
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
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.eduDOI: 10.1002/lary.25002
Laryngoscope 00: Month 2014
Kim et al.: Cost of Foreign Body Aspiration in Children
Reprinted by permission of Laryngoscope. 2014 Nov 1. doi:10.1002/lary.25002. (Epub ahead of print).
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