Abstract / Summary
Abstract Background Tracheobronchial foreign body (TFB) represents a life-threatening pediatric emergency. Chest CT is frequently used for radiological evaluation of children with suspected TFB; nevertheless, false-negative CT interpretations occur even among bronchoscopically confirmed cases, creating diagnostic challenges in pediatric radiology. This study aimed to identify factors associated with missed CT detection of TFB. Methods We retrospectively analyzed 951 children with bronchoscopically confirmed TFB. CT detection versus missed detection was defined based on original radiology reports from routine clinical care. Data on demographics, clinical features, and concomitant imaging findings were collected. Three independent multivariable logistic regression models with different codings of concomitant imaging findings were constructed, with bootstrap internal validation. Results The missed detection rate was 8.6% (82/951). Absence of a definite aspiration history was the most robust independent factor (OR range 2.70–2.87, all P ≤ 0.001). The strongest associations were observed in children aged 3–6 years (mean OR 4.76), followed by location in the trachea, carina, or glottis (mean OR 4.19), right bronchus (OR ≈ 2.0), and age 1–3 years (mean OR 1.95). Concomitant imaging findings showed heterogeneous associations: mixed-type (OR = 4.27) and single-type findings (OR = 2.62) significantly increased risk, whereas purely obstructive/masking findings or the presence of two or more types were not. Duration of aspiration and granulation tissue were not independently associated. Conclusions Absence of a definite aspiration history, age 3–6 years or 1–3 years, and foreign body location in the trachea, carina, glottis or right bronchus are independent factors associated with missed CT detection. Mixed or solitary concomitant imaging findings also increase risk. These factors may help radiologists identify children at high risk for CT false-negative