Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.

Title

Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.

Creator

Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA

Publisher

Journal of Pediatric Surgery

Date

2020
2020-01

Description

BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.

Subject

Humans; Male; Female; Unnecessary Procedures; Infant; Adolescent; Child; Sensitivity and Specificity; Child Preschool; Retrospective Studies; Tomography X-Ray Computed; Observer Variation; Bronchoscopy; Bronchoscopy; Computed tomography; Foreign Bodies/diagnostic imaging/therapy; Foreign body aspiration; Respiratory System/diagnostic imaging

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

Search for Full-text

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Pages

176-181

Issue

1

Volume

55

ISSN

1531-5037 0022-3468

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of Radiology

Update Year & Number

Hospital List

Affiliated Hospital

Akron Children's Hospital

Citation

Gibbons AT; Casar BAM; Hanke RE; McNinch NL; Person A; Mehlman T; Rubin M; Ponsky TA, “Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.,” NEOMED Bibliography Database, accessed December 1, 2021, https://neomed.omeka.net/items/show/11458.

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