PO-0284 Use Of Soft Tissue Neck Radiographs In Paediatric Acute Airway Obstructions: Current Perspective

Abstract

Background Soft tissue neck radiographs (STNRs) have been recognised as a helpful tool to differentiate benign causes of acute upper airway obstructions (AUAO) from epiglottitis, retropharyngeal abscess or foreign body aspiration. Based on the frequency at which those life-threatening pathologies now occur, are STNRs still widely used and what is the impact of their clinical use? Methodology A retrospective study was conduct. Medical files from children aged 0–17 who had a STNR between January 1st 2010 and December 31st 2011 in a mid-size Canadian university paediatric hospital were reviewed. Patients were divided in 2 groups according to the conditions clinicians first suspected and compared the STNRs’ interpretations with Fisher exact test. Cases of epiglottitis and retropharyngeal abscess for the same period were reviewed. Results Among 520 STNRs identified, 88% intended to evaluate AUAO among children. Nearly all (99%) took place at the emergency room, with 73% of patients presenting with triage score 3 and above, and 49% necessitating admission. Most STNR were performed among males (67%) aged below 5 y.o. (66%; mode=1 y.o.). A life-threatening cause of AUAO was first suspected by clinicians among 40% of reviewed charts. Convincing radiologic signs of life-threatening pathologies were found in 40 children (9%). Overall, 2 cases of epiglottitis and 8 retropharyngeal abscesses were diagnosed during the study period. Conclusion STNR is a radiologic study that is frequently used among children. The current value of STNRs appears uncertain as few showed solid evidences that may modify how clinicians currently manage paediatric AUAO.