Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
ORL J Otorhinolaryngol Relat Spec. 2022;84(3):193-199. doi: 10.1159/000517307. Epub 2021 Jul 30.
Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training.
The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital's Emergency Department for UADT-FB during June 2013-August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients.
Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2.
DISCUSSION/CONCLUSION: This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases.
异物摄入是耳鼻喉科专家在急诊科就诊的最常见原因。在不同类型的异物中，鱼骨最为常见，尤其是在亚洲人群中。在台湾，上呼吸道消化道异物（UADT-FB）主要由耳鼻喉科（ORL）住院医师处理。考虑到所有程序所需的学习曲线、住院医师之间不同的管理类型以及可能导致的安全问题，本研究探讨了不同年资 ORL 住院医师在 UADT-FB 管理方面的结果。
回顾性分析了 2013 年 6 月至 2019 年 8 月期间因 UADT-FB 到高雄荣民总医院急诊科就诊的 2283 例患者的病历。回顾的数据包括纳入患者的人口统计学数据、异物管理结果以及患者的随访图表记录。
在 2283 例患者中，1324 例（58%）为阴性，951 例（41.7%）立即取出异物。在阴性发现（NF）组中，2 例（4.9%）患者在门诊随访中后来发现有异物。1 例（2.4%）患者发生深部颈感染和食管穿孔。NF 的百分比从第一年上半年住院医师（R1a）的 62.58%下降到第三年住院医师（R3）的 54%。与 R3 相比，R1a 患者在急诊就诊后仍有 UADT-FB 残留的危害人数需要 12.2。
讨论/结论：本研究提供了来自 1 家转诊中心的数据，涉及 UADT-FB 的管理。随着住院医师培训的增加，NF 的百分比从 62.58%下降到 54%。年轻的住院医师，尤其是培训前 6 个月的住院医师，如果在疑似病例中未发现 UADT-FB，应让上级住院医师进行第二次检查。
