Moreau Damien, Evain Jean-Noël, Mortamet Guillaume, Atallah Ihab
Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, Cedex 09, France; Grenoble Alpes University, School of Medicine, Domaine de la Merci, BP 170 La Tronche, 38042, Grenoble, Cedex 9, France.
Department of Paediatric Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital, BP 217, 38043, Grenoble, Cedex 09, France.
Int J Pediatr Otorhinolaryngol. 2024 Aug;183:112033. doi: 10.1016/j.ijporl.2024.112033. Epub 2024 Jul 9.
Tracheobronchial foreign body aspiration is a common pediatric emergency and a leading cause of accidental deaths in children. The diagnosis remains sometimes difficult even with physical examination, medical history, and basic X-rays. This challenge necessitates the performance of endoscopy under general anesthesia, regardless of the potential for serious complications. The benefit of strategies like expiratory chest X-rays to reduce unnecessary endoscopies remains uncertain. We evaluated the effectiveness of expiratory chest X-rays in detecting airway foreign bodies to potentially reduce the need for endoscopies.
We retrospectively studied children with suspected foreign body aspiration who had X-ray and endoscopy.
A total of 70 children were included in the study. Out of these, 19 cases (27.1 %) showed pathological findings on standard chest X-rays. However, when expiratory chest X-rays were added, the number of pathological radiographies increased to 37 cases (52.9 %). Out of the 36 foreign bodies that were present, only 2 were not detected. Furthermore, 3 chest X-rays displayed pathological results, while the endoscopies indicated normal findings. Consequently, the overall sensitivity, specificity, positive predictive value, and negative predictive value stood at 94.4 %, 91.1 %, 91.9 %, and 93.9 % respectively.
The remarkable sensitivity of expiratory chest radiography can eliminate the need for unnecessary endoscopy, but it should be limited to centers lacking access to MDCT. The performance of endoscopy should only be considered when persistent clinical symptoms are observed during auscultation.
气管支气管异物吸入是常见的儿科急症，也是儿童意外死亡的主要原因。即使结合体格检查、病史和基础X线检查，有时诊断仍有困难。这一挑战使得无论存在严重并发症的可能性如何，都有必要在全身麻醉下进行内镜检查。呼气胸部X线等策略减少不必要内镜检查的益处仍不确定。我们评估了呼气胸部X线在检测气道异物方面的有效性，以潜在减少内镜检查的需求。
我们回顾性研究了疑似异物吸入且接受了X线检查和内镜检查的儿童。
共有70名儿童纳入研究。其中，19例（27.1%）在标准胸部X线下显示病理结果。然而，当增加呼气胸部X线检查时，病理影像学检查的病例数增加到37例（52.9%）。在存在的36个异物中，仅两个未被检测到。此外，3次胸部X线显示病理结果，而内镜检查显示正常结果。因此，总体敏感性、特异性、阳性预测值和阴性预测值分别为94.4%、91.1%、91.9%和93.9%。
呼气胸部X线检查具有显著的敏感性，可避免不必要的内镜检查，但应限于无法进行MDCT检查的中心。仅在听诊时观察到持续临床症状时才应考虑进行内镜检查。
