PEDIATRIC TRACHEOBRONCHIAL FOREIGN-BODIES - HISTORICAL REVIEW FROM THE JOHNS-HOPKINS HOSPITAL

We investigated changing trends in pediatric tracheobronchial foreign body removal and resident experience from 1939 to 1991. We retrieved t he records of 234 cases of tracheobronchial foreign body removal at Jo hns Hopkins. The mean number of cases per year was 5.9. The most commo n foreign bodies removed were peanuts, accounting for 38.9%. The avera ge yearly incidence of pediatric tracheobronchial foreign bodies remai ned relatively constant during the period studied. Our data suggested little change in outcome or complications with the advent of optical t elescopes in the mid-1970s, despite their great value in improved visu alization. Resident experience and training were evaluated by the numb er of cases attended by each resident during his or her training. The number varied from 1 to 8 cases, not including experience acquired at our sister institutions. Although complete data could not be obtained in many of the older medical records, our review suggests that despite the advantage offered by the optical forceps technology, proper train ing and experience in traditional rigid endoscopic techniques is still crucial to optimize outcome and minimize the risk of complications in pediatric tracheobronchial foreign body removal. Chevalier Jackson's recommendation that residency training include an animal laboratory co urse in foreign body removal still applies.