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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
[Lateral soft tissue neck x ray] + [foreign body]

Search 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)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Karnwal et al 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.
Marais et al 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
Wai Pak et al 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

Clinical Bottom Line

No evidence that lateral soft tissue neck x-rays influence use of endoscopy in non-aspirated upper airway foreign bodies

References

1. 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? Journal of Laryngology and Otology 2008; 122 (8): 845-7
2. Marais J, Mitchell R, Wightman AJA The value of radiographic assessment for oropharyngeal foreign bodies. The Journal of Laryngology and Otology 1995; 109 (5): 452-4
3. Wai Pak M, Chung Lee W, Kwok Fung H, van Hasselt CA A prospective study of foreign-body ingestion in 311 children. International Journal of Pediatric Otorhinolaryngology 2001; 58: 37-45