Purpose
The primary aim of this study was to quantify the accuracy of x-ray and computed tomography (CT) and to test the perception that plain film radiography can be used to rule out bone impaction.
Methods and materials
A retrospective multicentre cohort study of patients presenting to Eastern Health Emergency Departments was conducted between January 2010 to December 2015.
Ethics approval was obtained from the Office of Research and Ethics,
Eastern Health.
Reference number: LR08/2016.
Out of the 167 patients who presented to the emergency departments with suspected fish or chicken bone impaction,
96 patients were included in the study (figure 1).
Electronic and paper records from the emergency departments and hospital wards were accessed to obtain various variables.
The gold standard of...
Results
The sensitivity for x-ray was 44% and specificity was 73% with a positive predictive value of 50% and negative predictive value of 69%.
The sensitivity of CT was 88%,
specificity 71%,
positive predictive value 65% and negative predictive value 90%.
There was no significant difference in terms of gender or race and bone impaction rates (P-value= 0.66 and 0.84,
respectively).
The mean age of presentations for true bone impaction was 55 and for false bone impaction 47.
The difference was significant (P-value= 0.02) (table 1)....
Conclusion
Due to the low sensitivity of x-ray,
we do not recommend its use to rule out bone impaction.
Further research should be performed to evaluate the utilisation of lowdosemultidetector CT scanning.
References
1.
Ngan JH,
Fok PJ,
Lai EC,
Branicki FJ,
Wong J.
A prospective study on fish bone ingestion.
Experience of 358 patients.
Annals of surgery.
1990;211(4):459-62.
2.
Devarajan K,
Voigt S,
Shroff S,
Weiner SG,
Wein RO.
Diagnosing Fish Bone and Chicken Bone Impactions in the Emergency Department Setting: Measuring the System Utility of the Plain Film Screen.
The Annals of otology,
rhinology,
and laryngology.
2015;124(8):614-21.
3.
Palme CE,
Lowinger D,
Petersen AJ.
Fish bones at the cricopharyngeus: a comparison of plain-film radiology and computed...