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hospital institutional review board and deemed exempt from
review. For each of these calendar years, all admissions with a
pediatric (age
!
16 years) foreign-body aspiration diagnosis code
(International Classification of Diseases [ICD]-9 diagnosis
codes: 934.0, 934.1, 934.8, and 934.9) were extracted. The data
were then imported into SPSS (version 21.0, Chicago, Illinois)
for analysis.
Standard descriptive demographic information was com-
puted for the admission population. The incidence of food ver-
sus object aspiration, the airway procedure intervention rate
(ICD-9 procedure codes—bronchoscopy: 33.22, 33.23, and
33.24; bronchoscopy with foreign body removal: 98.15; laryn-
goscopy or tracheoscopy: 31.42; foreign body removal from lar-
ynx, pharynx, or site not otherwise specified: 98.13, 98.14 and
98.20) were determined. Data for length of stay, total charges,
and actual costs were extracted and divided into quartiles
because they were not normally distributed. The mean values
for length of stay, total charges, and actual costs were com-
puted for each quartile.
Finally, disposition status for the population including
inpatient death and the incidence of anoxic brain injury (ICD-9
code 348.1) was also tabulated. Data were analyzed using the
complex sample algorithm, which takes into account survey
design variables contained within the NIS that allow for estima-
tion of these variables at the national level. In accordance with
published analyses from the Agency for Healthcare Research
and Quality, data were considered reliable as a national esti-
mate if the relative standard error of the estimate was less
than 30%.
4
RESULTS
An estimated 1,908
6
273 pediatric bronchial
foreign-body aspiration patients were admitted annually
over a 3-year period. Of this group, 61.3%
6
1.9% were
male, with an average age at presentation of 3.6
6
0.25
years. The ratio of nonfood foreign object aspiration to
food aspiration was 5:3. Approximately half of the
patients (56.0
6
3.6%) underwent an airway endoscopic
procedure (1068
6
117 cases, annually) for diagnostic
and/or therapeutic purposes. Among those children
undergoing airway endoscopy, 41.5%
6
2.5% had a for-
eign body removed at the time of the endoscopy. Follow-
ing their hospital stay, 86.6%
6
2.0% of patients were
discharged to home without nursing care; 5.3%
1
1.6%
were discharged to home with home healthcare;
3.5%
1
0.7% were transferred to another hospital; and
2.6%
1
0.5% were transferred to a skilled care facility.
Forty-one patients (2.2%
6
0.5%) suffered anoxic brain
injury and 34 patients died, representing a hospital mor-
tality rate of 1.8%
6
0.4%.
Data for length of stay, total charges, and actual
costs were extracted and divided into quartiles because
they were not normally distributed. 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. Table I presents the means for
length of stay, charges, and actual costs for each quar-
tile, as well as the overall means for these values.
DISCUSSION
Bronchial FBA continues to pose a significant
healthcare concern in the pediatric population. Although
the vast majority of these events are nonfatal, thousands
of patients present to the emergency room for evalua-
tion, procedures, and admissions. Our study, which
included aggregated 2009 to 2011 data from the NIS,
included information from nearly 1,149 (unweighted N)
admissions. Incorporating sample weights and the struc-
tured survey design variables from the NIS allows for
extrapolation to an overall national estimate of
1,908
6
273 pediatric airway foreign bodies, with approx-
imately $41.0 million in inpatient healthcare expendi-
tures annually.
There exists some heterogeneity in the literature
regarding the most common type of foreign body aspi-
rated among pediatric patients; a recent study reviewing
72 articles showed that 94% of studies reported food for-
eign bodies as the most frequently aspirated items.
1
In
our study, the ratio of nonfood object aspiration to food
object aspiration in the study was 5:3. Regardless of
whether an aspirated object is edible or not, its size and
shape are important considerations. Various cylindrical
and spherical objects (nuts, hard candies, grapes, mar-
bles) are capable of occluding the pediatric airway.
1
What remains constant and perpetually concerning is
the morbidity of these events, as well as the nonnegli-
gible incidence of anoxic brain injury and death (2.2%
and 1.8%, respectively, in this study). This is the first
study to quantify the incidence of anoxic brain injury
with bronchial foreign body aspiration. Clearly, these
rates for anoxic brain injury and mortality are concern-
ing in and of themselves.
Currently, to our knowledge, no studies reviewing
data regarding only airway FBA admissions have been
performed. There does exist a study of patient admis-
sions for both airway and esophageal foreign bodies from
the Kids’ Inpatient Database 2003 performed by Shah
et al.; there was a 3.4% mortality rate among patients
and the average length of stay was 11.7 days.
5
The
mean total charges were $34,652.
5
Our study, which
focused on bronchial foreign body aspirations alone,
showed a $20,820 charge for each hospital admission
and an annual overall inpatient cost associated with
pediatric bronchial FBA to be approximately $12.8 mil-
lion. One notable difference between our study and that
of Shah et al. concerns the sampled hospitals. Shah
et al. examined foreign body admissions in a database of
TABLE I.
Quartile Stratification and Overall Mean Length of Stay, Actual
Costs, and Total Charges per Hospital Admission.
Quartile Mean Length of Stay Actual Costs ($)
Total Charges ($)
First
0.80
6
0.02 days 2,306
6
52
6,518
6
173
Second 2.00
6
0.01 days 5,046
6
57
15,371
6
171
Third 4.12
6
0.07 days 10,648
6
211 33,118
6
699
Fourth 21.0
6
1.13 days 68,475
6
3831 209,537
6
14,207
Overall
mean
7.08
6
0.96 days 21,479
6
2,432 65,590
6
7,819
Laryngoscope 00: Month 2014
Kim et al.: Cost of Foreign Body Aspiration in Children
2