Predictability of Different Scoring Systems for Suspected Airway Foreign Body in Children: A Retrospective Study

Background: Foreign body aspiration (FBA) is a frequent pediatric emergency; however, its diagnosis remains challenging due to nonspecific symptoms and clinical presentations, which may delay its management. Objective: The objective is to evaluate the diagnostic usefulness of the FOBAS (FBA score) and Janahi et al . scoring systems in children undergoing rigid bronchoscopy for suspected FBA, and to develop a locally applicable scoring model based on clinical and examination findings. Methodology: A retrospective cohort study was conducted of all patients <14 years who underwent rigid bronchoscopy for suspected FBA between 2019 and 2024. Each case was scored using the FOBAS and Janahi et al . Systems, and correlated with bronchoscopy outcomes. Multivariate logistic regression was used to identify independent predictors and generate a weighted scoring model. Results: Of the 54 patients, 42 (77.8%) had a confirmed airway foreign body. Choking ( P = 0.009) and sudden, persistent cough ( P = 0.038) were the only history elements significantly associated with positive bronchoscopy. Chest radiography lacked discriminatory value, with over half of positive bronchoscopy cases (54.8%) showing normal X-rays. The proposed scoring model demonstrated good discrimination (area under the curve [AUC] = 0.748), and 81% of confirmed cases fell into the high-risk category. The FOBAS system showed slightly better performance (AUC = 0.750) compared to the Janahi model (AUC = 0.739). Conclusion: Choking and sudden persistent cough were the strongest predictors of FBA, whereas chest radiography had limited diagnostic value. The proposed scoring system showed good discrimination and may serve as a practical tool. Larger prospective studies are needed to validate this model.