Caught in the Airways: National Trends and Outcomes of Foreign Body Aspiration over a Decade

Introduction: Foreign body aspiration is a common clinical emergency with limited anecdotal reports on object prevalence and outcomes. Using the Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS), we assessed trends in aspirated objects by object type, year, and clinical disposition.

Methods: NEISS data was queried for pediatric (≤17 years) and adult (≥18 years) aspiration events from 2014–2023. Descriptive analyses characterized age, disposition, and object prevalence using R 4.4.2. Trends were evaluated with linear regression, logistic regression and chi-square or Fisher’s exact tests.

Results: From 2014–2023, 5,105 suspected aspiration events corresponded to an estimated 119,957 cases nationally. Adults most commonly aspirated food (n=49), barbecue grill wire (n=48), and toothpicks (n=43), while children aspirated jewelry (n=935), coins (n=445), and paper products (n=322). Children accounted for 88.0% of cases, with a median age of 2 years in a right-skewed, bimodal distribution. Over 10 years, adult aspiration events significantly increased from 48 in 2014 to 63 in 2023 (β=2.68, p=0.027), while pediatric events significantly decreased from 489 to 296 (β=−26.64, p=0.031). Adults had higher rates of hospitalization (19.12% vs. 13.29%, p< 0.001) and death (0.49% vs. 0.16%, p< 0.001). Among the three most aspirated items in adults, hospitalization was most likely for food (OR=2.59 vs. toothpicks, p=0.058), grill wire (OR=1.59 vs. toothpicks, p=0.414), followed by toothpicks. For children, hospitalization was most likely for coins (OR=21.01 vs. jewelry, p< 0.001), and paper products (OR=2.44 vs. jewelry, p< 0.001), followed by jewelry.

Conclusions: Over a decade, aspiration events declined in children but increased in adults. Children were more likely to be discharged, while adults had higher hospitalization and mortality rates. Aspirated coins in pediatrics carried the highest risk for hospitalization. These findings highlight the need for prevention and safety measures for adults, and for pediatric coin aspirations.