Update Course Rewind: CT Evaluation of Suspected Airway Foreign Body 2022

Every parent has worried about it and every pediatric surgeon has seen it. The child who's ingested a Lego or toy or crayon or some other household item. In fact, we've done a full length podcast on this very topic with Dr. Eric Garson. But today, we're going to focus on the diagnostic workup of airway foreign bodies and how the paradigm might be changing. In today's update course rewind, we welcome Dr. Chuck Snyder to discuss how to use computed tomography or CT scans in the diagnosis of pediatric airway foreign bodies. A 9-year-old child presents after choking episode at home associated with transient respiratory distress. She has a prior history of asthma. In the emergency department, she appears in no distress with an expiratory wheez on exam. Chest X-ray is normal. The parents are concerned about the risk of negative bronchoscopy given her history of asthma. So what is the most appropriate management? And we pulled the audience. Most are saying CT, but you introduced it as the topic of CT for airway foreign body. So they're cheating. It just highlights a report in the Journal of Pediatric Surgery that Dr. Ponky was the author on. In this study, cohort one went straight to bronchoscopy, while cohort two underwent CT scan. If the CT scan was negative, then the child was sent home, and if the CT scan was positive, the child went to the operating room. And those that went to the operating room, 94% of the time, they actually found a foreign body. Another example is an institution where there's no ENT or pediatric surgery expertise available and they have a child with that they could sometimes avoid intervention or avoid transferring them to some other institution in that circumstance. If it's clearly if airway aspiration, you go to the operating room. The ones you don't know, it's a suspicious story, they were coughing after eating. More often than not, it's reactive airway and it's not a foreign body. So you're instrumenting the airway of kids that already have a reactive airway. It made no sense. We were having a lot of negative bronks because we were so worried. CT scan will direct your management. That is if you need to go to the operating room or not. So overall, it's very low radiation and it eliminates those equivocal patients who were otherwise getting unnecessary instrumentation of their airway in the face of reactive airway disease. What are the reasons for the false negatives on the CT scans so we can alert folks who are using that technology. That was like mucus or something like that, you'd go in and it was a false positive. False positives were very unusual, like 6% or something like that. The only way to know if it's a false negative is did something happen to them afterwards? You would never know, right? And of all the patients that were called, not a single one had any problems after discharge from the emergency room. It's incredibly surprisingly accurate and they do not need to be radio opaque. It can be plastic, it can be anything. Thanks for joining Dr. Snyder along with the rest of the ABS professional development Committee for this update course rewind. Remember to check out the Stay current app for more content related to pediatric surgery and more.