Assefa Dagnachew, Amin Nikhil, Stringel Gustavo, Dozor Allen J
Respiratory Center for Children, Morristown Memorial Hospital, Atlantic Health System, Morristown, NJ, USA.
Pediatr Emerg Care. 2007 Mar;23(3):154-7. doi: 10.1097/PEC.0b013e3180328cd8.
Lateral decubitus radiographs are often obtained in young children with suspected foreign body aspiration. Their usefulness has not been well studied.
To assess the value of decubitus radiographs in detecting foreign body aspiration in young children and compare their value to history and physical examination.
Retrospective review of children younger than 4 years with suspected foreign body aspiration who had decubitus radiographs and underwent bronchoscopy over a 5-year period. Patients with proven foreign body aspiration were compared with those without foreign bodies for differences in symptoms, signs, location and character of the foreign body, and the diagnostic value of standard and decubitus chest radiographs.
Twenty-eight of 41 children who underwent bronchoscopy for possible foreign body aspiration had decubitus radiographs. Foreign bodies were identified in 22 patients (79%). A total of 27% of children with foreign body aspiration and 33% of children without a foreign body had suggestive decubitus radiographs (P = not significant). As a measure of detecting foreign body aspiration, positive decubitus radiographs had a sensitivity of 27%, a specificity of 67%, a positive predictive value of 75%, and a negative predictive value of 20%. The odds ratio of finding a foreign body with suggestive decubitus radiographs was 0.75 (95% confidence interval [CI], 0.1-5.2; P = 0.57). Foreign body aspiration was confirmed in 94% of children if there was both a sudden onset of symptoms and a witnessed choking episode (odds ratio, 13.3; 95% confidence interval, 1.3-138.9; P = 0.02).
Decubitus chest radiographs, at least as routinely performed and interpreted, seem to add little to the evaluation of young children with suspected foreign body aspiration. A history of a witnessed choking episode combined with a sudden onset of respiratory symptoms remains the most important indication for bronchoscopy.
对于疑似有异物吸入的幼儿，常拍摄侧卧位X线片。但其效用尚未得到充分研究。
评估侧卧位X线片在检测幼儿异物吸入方面的价值，并将其价值与病史及体格检查进行比较。
回顾性分析5年间4岁以下疑似异物吸入且拍摄了侧卧位X线片并接受支气管镜检查的儿童。将确诊有异物吸入的患者与无异物的患者在症状、体征、异物位置及特征以及标准胸部X线片和侧卧位胸部X线片的诊断价值方面进行比较。
41例因可能有异物吸入而接受支气管镜检查的儿童中有28例拍摄了侧卧位X线片。22例（79%）患者发现有异物。有异物吸入的儿童中27%以及无异物的儿童中33%的侧卧位X线片有提示意义（P值无统计学意义）。作为检测异物吸入的一种手段，阳性侧卧位X线片的敏感度为27%，特异度为67%，阳性预测值为75%，阴性预测值为20%。有提示意义的侧卧位X线片发现异物的比值比为0.75（95%置信区间[CI]，0.1 - 5.2；P = 0.57）。如果既有症状突然发作又有目睹的呛咳事件，则94%的儿童确诊有异物吸入（比值比，13.3；95%置信区间，1.3 - 138.9；P = 0.02）。
至少按照常规方式进行拍摄和解读的侧卧位胸部X线片，对于疑似异物吸入的幼儿评估似乎作用不大。目睹的呛咳事件病史加上呼吸道症状突然发作仍是支气管镜检查的最重要指征。
