Lateral soft tissue neck x-ray in non-aspirated upper airway foreign body impaction
Date First Published:
April 14, 2013
Last Updated:
April 14, 2013
Report by:
Caitriona Considine, CT3 EM (Monklands Hospital)
Three-Part Question:
[In upper airway aero-digestive tract non-aspirated foreign body] does [lateral soft tissue neck x-ray] [influence use of endoscopy]
Clinical Scenario:
A 48yr old male attends your ED with a sensation of foreign body in his hypopharynx after eating lamb curry. You feel he warrants naso-endoscopy and refer him to ENT. You are asked to order a lateral soft tissue neck x-ray by your ENT colleagues. You wonder if this will alter his management.
Search Strategy:
Medline
Search Details:
[Lateral soft tissue neck x ray] + [foreign body]
Outcome:
23 papers found. 19 failed to answer question. 2 papers inaccessible without journal subscription. Further reference found through linked citation. 3 papers discussed below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Lateral soft tissue neck x-rays: are they useful in the management of upper aero-digestive tract foreign bodies? Karnwal A, Ho EC, Hall A, Molony N 2008 UK | Patients referred to ENT with a history of non-aspirated upper aero-digestive tract foreign body with a lateral soft tissue neck x-ray taken on admission | Retrospective study | To assess value of lateral soft tissue neck x-ray in these patients | X-ray \\\'useful\\\' in 51% cases. 24 patients with positive x-rays (foreign body seen in 6, \\\'soft signs\\\' seen in all 24). 8 negative x-rays in radiopaque foreign bodies | No statistical analysis. Results unclear: \\\'soft signs\\\' seen in all 27 radiopaque foreign bodies but only 8 x-rays \\\'positive\\\'. No description of how x-ray aided patient management. |
| The value of radiographic assessment for oropharyngeal foreign bodies. Marais J, Mitchell R, Wightman AJA 1995 UK | Patients with suspected oro/hypopharyngeal foreign body impaction attending ED with lateral soft tissue neck x-rays, referred to ENT. All patients had negative direct laryngoscopy and proceeded to endoscopy | Double-blind controlled study | To establish accuracy in interpretation of lateral soft tissue neck x-rays among ENT, ED and radiology doctors | Foreign body correctly identified in 39% (ENT), 42% (ED) and 34% (radiology) cases. False positive foreign body diagnosis in 26% (ENT), 34% (ED) and 19% (radiology) cases. | No statistical analysis |
| A prospective study of foreign-body ingestion in 311 children. Wai Pak M, Chung Lee W, Kwok Fung H, van Hasselt CA 2001 Hong Kong | All patients 12yrs and below, presenting with a history of foreign body ingestion to ED. All patients managed as per hospital protocol. | Prospective study | To evaluate the clinical features, diagnosis and treatment of foreign body ingestion in children | All (311) patients had neck x-rays. 115 children had foreign body impaction. 19/308 x-rays were positive or suspicious of foreign body. Sensitivity of neck x-ray 15.9%, specificity 99.5% | 3 x-rays excluded due to \\\'poor quality\\\', which may have influenced their interpretation. Unclear who interpreted x-rays and whether interpreted pre- of post-endoscopy |
Bottom Line:
No evidence that lateral soft tissue neck x-rays influence use of endoscopy in non-aspirated upper airway foreign bodies
References:
- Karnwal A, Ho EC, Hall A, Molony N. Lateral soft tissue neck x-rays: are they useful in the management of upper aero-digestive tract foreign bodies?
- Marais J, Mitchell R, Wightman AJA. The value of radiographic assessment for oropharyngeal foreign bodies.
- Wai Pak M, Chung Lee W, Kwok Fung H, van Hasselt CA. A prospective study of foreign-body ingestion in 311 children.