Abstract
Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.
Highlights
Fish bone impaction in the upper aerodigestive tract represents a common emergency department (ED) presentation and one which frequently requires review by otolaryngology specialists
Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector computed tomography (CT) scanners may replace plain film radiography as a screening tool
A total of 73 patients were included in the final analysis from the period of 2010 and 2015 with suspected fish bone impaction
Summary
Fish bone impaction in the upper aerodigestive tract represents a common emergency department (ED) presentation and one which frequently requires review by otolaryngology specialists. Such patients can present with variable symptomatology ranging from severe pain and odynophagia to being relatively asymptomatic. In a prospective study of fish bone impaction a “sharp pricking sensation on swallowing” had the best predictive value of any symptom (76%) [1]. Other symptoms included pain on swallowing, foreign body sensation, pain. The duration of symptom onset to presentation at ED showed a correlation with the presence of fish bone on endoscopy with the yield of fish bone retrieval decreasing as the duration increased [1]
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