Protocol incorporating airway CT decreases negative bronchoscopy rates for suspected foreign bodies in pediatric...

Area of Science:

• Pediatric Pulmonology
• Medical Imaging
• Emergency Medicine

Background:

• Foreign body aspiration (FBA) is a critical cause of mortality in young children.
• Direct laryngoscopy and bronchoscopy (DL&B) is the standard diagnostic tool but has a high rate of negative findings.
• Unnecessary DL&B exposes children to significant operative, anesthetic, and financial risks.

Purpose of the Study:

• To evaluate the effectiveness of a clinical care protocol using low-dose non-contrast airway computed tomography (CT) in reducing negative bronchoscopy rates.
• To assess the diagnostic performance of airway CT in identifying pediatric airway foreign bodies.

Main Methods:

• Implementation of a clinical care protocol involving selective low-dose non-contrast airway CT for intermediate-risk FBA cases.
• Retrospective review comparing negative bronchoscopy rates before and after protocol implementation.
• Analysis of airway CT's diagnostic performance characteristics for foreign bodies.

Main Results:

• The negative bronchoscopy rate decreased from 37% to 17% after protocol implementation (p=0.06).
• Airway CT demonstrated high diagnostic accuracy: 91% sensitivity, 100% specificity, 100% positive predictive value, and 97% negative predictive value for foreign bodies.

Conclusions:

• Selective use of low-dose non-contrast airway CT in a clinical protocol effectively reduces negative bronchoscopy rates in children.
• This imaging strategy significantly lowers operative risks and healthcare costs associated with suspected FBA.