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Title: Validity of Chest X-Ray in the Diagnosis of Airway Foreign Body; Analysis of 112 Cases
Authors: Muhammad Rashid, Humaira Saleem, Saeed Bin Ayaz, Ijaz -un- Nabi, Rashida Hussain, Faisal Manzoor
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2022
Volume: 72
Issue: 2
Language: English
Keywords: ValidationForeign bodyAspirationBronchoscopyChest x-ray
Objective: To find out the validity of chest x-ray (CXR) in patients suspected of foreign body (FB) aspiration in our population considering bronchoscopy and/or thoracotomy as gold standards.
Study Design: A prospective validation study.
Place and Duration of Study: Departments of thoracic surgery, otorhinolaryngology, and diagnostic radiology from Combined Military Hospitals of Rawalpindi, Lahore, Malir, and Quetta and Pakistan Naval Ship Shifa, Karachi Pakistan, from Aug 2006 to Nov 2017.
Methodology: We included consecutive patients who underwent bronchoscopy and/or thoracotomy for suspected FB aspiration and recorded the findings observed on bronchoscopy and/or thoracotomy. The available radiological data pertinent to all included patients were recovered from the patients and the respective radiological departments. The CXRs were carried out in poster anterior or anteroposterior and lateral views and reviewed by consultant radiologists. All bronchoscopies were done using Karl Storz Ventilating Bronchoscopes.
Results: Out of 112 patients with FB aspiration, (mean age: 6 ± 7 years, range 1-45 years), 77 (68.8%) cases were male and 35 (31.3%) were females. Chest x-rays were normal in 27(24.1%) cases, while in 85 (75.9%) cases, a direct or indirect evidence of FB aspiration was observed. The commonest radiological finding was a radiopaque FB in 31(27.7%) cases. The sensitivity of CXR was 76.4%, while specificity was 50%, with positive predictive value of 98.8%, and negative predictive value of 3.7%. The accuracy rate was 76%.
Conclusion: Chest x-ray is a good screening tool for the diagnosis of airway FB but a normal CXR does not always rule out FB aspiration in patients with a positive clinical evaluation.
To determine the validity of chest X-ray (CXR) in patients suspected of foreign body (FB) aspiration, using bronchoscopy and/or thoracotomy as the gold standard.
A prospective validation study conducted in the departments of thoracic surgery, otorhinolaryngology, and diagnostic radiology across multiple Combined Military Hospitals and a Pakistan Naval Ship. The study included 112 consecutive patients who underwent bronchoscopy and/or thoracotomy for suspected FB aspiration. CXRs were reviewed by consultant radiologists, and bronchoscopies were performed using Karl Storz Ventilating Bronchoscopes. Statistical analysis was performed using SPSS and MedCalc software to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.
graph TD
A["Patient Recruitment Suspected FB Aspiration"] --> B["Perform Chest X-ray"];
B --> C["Review CXR by Radiologists"];
A --> D["Perform Bronchoscopy/Thoracotomy"];
D --> E["Record Bronchoscopy/Thoracotomy Findings"];
C --> F["Compare CXR Findings with Gold Standard"];
E --> F;
F --> G["Statistical Analysis Sensitivity, Specificity, PPV, NPV, Accuracy"];
G --> H["Draw Conclusions"];
The study highlights that while CXR is a useful screening tool for airway FB aspiration, a normal CXR does not definitively rule out aspiration in cases with a positive clinical evaluation. The findings are discussed in the context of existing literature, noting the male predominance observed in the study population and the varying reported accuracy rates of CXR in diagnosing FB aspiration. The importance of direct airway examination via bronchoscopy is emphasized, especially when complications are suspected or when clinical suspicion remains high despite normal imaging.
Out of 112 patients, 85 (75.9%) showed direct or indirect evidence of FB aspiration on CXR. The most common radiological finding was a radiopaque FB (27.7%), followed by air trapping (21.4%) and lobar collapse (10.7%). The sensitivity of CXR was 76.4%, specificity was 50%, PPV was 98.8%, NPV was 3.7%, and the overall accuracy rate was 76%.
Chest X-ray serves as a good screening tool for diagnosing airway foreign body aspiration, with a sensitivity of 76.4% and an accuracy rate of 76%. However, a normal CXR should not preclude further investigation if clinical suspicion of FB aspiration is high.
* A total of 112 patients were included in the study.
* The sensitivity of CXR in diagnosing airway FB was found to be 76.4%.
* The study was conducted from August 2006 to November 2017.
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