Lateral neck x-rays are not indicated in the emergency department management of suspected fish bone impaction.
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Lesley Bethune, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
Rob Williams, Manchester Royal Infirmary
Three-Part Question:
In [patients who might have a fish bone in the throat] is [an x-ray of the neck] indicated to [diagnose and locate the bone]?
Clinical Scenario:
A 40 year old man attends the emergency department having recently eaten fish. He feels that a bone has got stuck in his throat. Examination of the oropharynx does not reveal a bone. You wonder whether an x-ray would aid diagnosis.
Search Strategy:
Medline 1966-06/99 using the OVID interface.
Search Details:
({exp fishes OR fish$.mp} AND {exp bone and bones OR bone$.mp} OR fishbone$) AND (exp pharynx OR throat.mp OR exp oropharynx OR oropharynx.mp}.
Outcome:
42 papers found of which 37 irrelevant and 2 of insufficient quality for inclusion. The three remaining papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A prospective study on fish bone ingestion. Experience of 358 patients. Ngan JH, Fok PJ, Lai EC et al. Hong Kong, 1990 | 310 of 358 patients over the age of 12 years complaining of fishbone ingestion | Prospective diagnostic | Sensitivity | 32% | |
| Specificity | 91% | ||||
| Positive predictive value | 66% | ||||
| The lateral neck radiograph in suspected impacted fish bones - does it have a role? Evans RM, Ahuja S, Rhys Williams S et al. Hong Kong, 1992 | 100 neck radiographs of patients with known fish bones mixed with 100 normal control films. Each assessed by two radiologists |
Diagnostic | Sensitivity | 25.30% | |
| Specificity | 86.30% | ||||
| Positive predictive value | 72.70% | ||||
| Value of radiography in the management of possible fishbone ingestion. Sundgren PC, Burnett A, Maly PV. Sweden, 1994 | 42 consecutive patients with fishbone ingestion | Retrospective diagnostic | Sensitivity | 28.60% | Small numbers |
| Specificity | 87.50% |
Author Commentary:
While there are many studies that show that fish bones can be seen on x-ray, the studies in the table show that the clinical utility and accuracy of lateral neck x-rays is poor in the clinical situation.
Bottom Line:
Lateral neck x-rays are not indicated in the emergency department management of suspected fish bone impaction.
References:
- Ngan JH, Fok PJ, Lai EC et al.. A prospective study on fish bone ingestion. Experience of 358 patients.
- Evans RM, Ahuja S, Rhys Williams S et al.. The lateral neck radiograph in suspected impacted fish bones - does it have a role?
- Sundgren PC, Burnett A, Maly PV.. Value of radiography in the management of possible fishbone ingestion.