Indication for Chest X-rays in the emergency department management of suspected aspiration of a tooth.
Date First Published:
October 5, 2010
Last Updated:
October 5, 2010
Report by:
Aileen Mc Cabe, ED Registrar (St James Hospital, Dublin, Ireland)
Three-Part Question:
In [patients who might have aspirated a tooth] is [a chest X-ray] indicated to [diagnose and locate the tooth]?
Clinical Scenario:
A 40 year old man attends the emergency department having sustained facial injuries following an alledged assault. Examination of the oropharynx reveals a missing tooth. The patient has no clear memory of what happened to his tooth. You wonder whether a chest x-ray would aid diagnosis.
Search Strategy:
("tooth"[MeSH Terms] OR "tooth"[All Fields]) AND ("injuries"[Subheading] OR "injuries"[All Fields] OR "trauma"[All Fields] OR "wounds and injuries"[MeSH Terms] OR ("wounds"[All Fields] AND "injuries"[All Fields]) OR "wounds and injuries"[All Fields]) AND ("inhalation"[MeSH Terms] OR "inhalation"[All Fields]) AND ("radiography"[Subheading] OR "radiography"[All Fields] OR "radiography"[MeSH Terms])
Search Details:
Medline 1966-10/2010 using the Pubmed interface.
Outcome:
13 studies were identified. One was a systematic review which was relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography. Pinto A, Scaglione M, Pinto F, Guidi G, Pepe M, Del Prato B, Grassi R, Romano L. 2006 Italy | 31 patients over a 5-year period were referred for observation for clinical suspicion of foreign-body aspiration. Suspected foreign-body aspiration had occurred 2-72 h before hospitalisation. | Positive chest radiographs | 21/31 patients (67.7%) [The 21 positive chest radiographs consisted of 7/31 (22.6%) demonstrating presence of a foreign body in the tracheobronchial tree including tooth fragment in three specific cases and 14/21 with radiological evidence of pleuroparenchymal lesions (atelectasis, pneumonia, pulmonary hyperinflation and pneumomediastinum)]. | Small numbers. Heterogenous causes of tracheobronchial foreign body aspiration were included. | |
| Positive bronchoscopy | 23/27 patients (85.2%) |
Author Commentary:
Only one recent study with small numbers and heterogenous foreign bodies was found in the search.
Bottom Line:
Plain chest radiography remains the initial imaging modality for patients with clinically suspected tracheobronchial aspiration of a foreign body. Bronchoscopy and/or multi-slice computed tomography should be considered if there is a high clinical suspicion of foreign body aspiration despite a normal plain film radiograph.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Pinto A, Scaglione M, Pinto F, Guidi G, Pepe M, Del Prato B, Grassi R, Romano L.. Tracheobronchial aspiration of foreign bodies: current indications for emergency plain chest radiography.