From
StayCurrentMD
Update Course Rewind: CT Evaluation of Suspected Airway Foreign Body 2022
With Dr. Chuck Snyder
Part of
Asthma 3 items
Chapter 3 of 4 · Diagnosis & Workup
Clinical rationale
Clinical rationale and false positive discussion
Cued at 1:42 · press play
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
More often than not, in cases with suspicious story of aspiration, it's reactive airway and not a foreign body
Instrumenting the airway of kids that already have a reactive airway when there is no foreign body makes no sense
The institution was having a lot of negative bronchoscopies because of high concern about missing foreign bodies
CT scan will direct management regarding whether the patient needs to go to the operating room or not
False positives on CT for airway foreign body were very unusual, approximately 6%
False negatives can only be determined by whether something happened to the patient afterwards
Of all patients with negative CT who were called for follow-up, not a single one had any problems after discharge from the emergency room
CT for airway foreign body is incredibly surprisingly accurate
Foreign bodies do not need to be radiopaque to be detected on CT
CT can detect plastic foreign bodies and other non-radiopaque materials
In the study by Dr. Ponsky, cohort one went straight to bronchoscopy, while cohort two underwent CT scan first
In the CT-first cohort, if the CT scan was negative, the child was sent home; if positive, the child went to the operating room
In patients who went to the operating room based on positive CT, 94% of the time they actually found a foreign body
The CT scan for airway foreign body has very low radiation exposure
CT eliminates unnecessary instrumentation of the airway in equivocal patients with reactive airway disease
