Jahshan Forsan, Sela Eyal, Layous Eli, Levy Einat, Assadi Niddal, Shilo Etgar, Ibrahim Nour, Maayan Dor, Ronen Ohad
Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Laryngoscope. 2018 Nov;128(11):2467-2472. doi: 10.1002/lary.27125. Epub 2018 Feb 15.
To establish clinical criteria for performing computed tomography scan for suspected upper digestive tract fishbone.
This is a prospective study of all adult patients referred to the otolaryngology emergency department at our medical center for suspected fishbone in the upper digestive tract after no fishbone was seen on physical examination. The patients were divided into two groups: 1) The first was a high clinical suspicion group, which included patients with at least one of the following criteria: drooling, accumulation of saliva in the sinus piriformis, fever, referral 24 hours after the ingestion with worsening/continuing symptoms, and readmission. These patients underwent nonenhanced CT scan (NECT) of the neck. 2) The second was a low clinical suspicion group, which included patients discharged with no NECT performed. These patients were followed at 1 week and 3 months.
One hundred and fourteen patients were included in the study; the median age was 41 years. Half of the patients arrived at the emergency department within 7 hours. There were no false negatives. The negative predictive value and sensitivity were 100%. Positive predictive value and specificity were 28.5% and 65%, respectively. Referral to the emergency department 24 hours after the ingestion with continuing symptoms had the highest false positive rate.
Our clinical criteria score for excluding foreign body fishbone in the upper aerodigestive tract was established. According to this score, a NECT can be spared in about 75% of all cases, thus reducing unnecessary ionizing radiation, stay at the emergency department, and costs with a very high NPV of almost 99%.
建立针对疑似上消化道鱼骨的计算机断层扫描的临床标准。
这是一项前瞻性研究，纳入了所有因上消化道疑似鱼骨而被转诊至我院医学中心耳鼻喉科急诊科的成年患者，这些患者经体格检查未发现鱼骨。患者被分为两组：1）高临床怀疑组，包括具有以下至少一项标准的患者：流涎、梨状窝唾液积聚、发热、摄入后24小时因症状加重/持续而转诊以及再次入院。这些患者接受颈部非增强CT扫描（NECT）。2）低临床怀疑组，包括未进行NECT扫描就出院的患者。对这些患者进行为期1周和3个月的随访。
114例患者纳入研究；中位年龄为41岁。一半的患者在7小时内到达急诊科。无假阴性病例。阴性预测值和敏感度均为100%。阳性预测值和特异度分别为28.5%和65%。摄入后24小时因症状持续而转诊至急诊科的患者假阳性率最高。
我们建立了排除上呼吸道消化道异物鱼骨的临床标准评分。根据该评分，在所有病例中约75%的患者可不必进行NECT扫描，从而减少不必要的电离辐射、在急诊科的停留时间和费用，阴性预测值高达近99%。
4。《喉镜》，2467 - 2472，2018年。
