Computerized Tomography Analysis of Young Children for Prevention of Aspiration Injuries
Nicholas M Milkovich1, Scott M Milkovich2, Mary P Harty3,4
1University of Virginia College of Engineering, Charlottesville, Virginia.
Insights
The Small Parts Test Fixture (SPTF) is smaller than the aerodigestive tract dimensions in young children. CT scans reveal that the SPTF may miss some choking hazards, suggesting a need for enlargement.
Area of Science:
- Pediatric Safety
- Medical Device Standards
- Anatomical Measurement
Background:
- The Small Parts Test Fixture (SPTF) is used to assess choking hazards in children.
- Recent studies indicate the SPTF may not accurately represent all potential foreign body (FB) sizes.
- Computed tomography (CT) offers detailed anatomical data for pediatric populations.
Purpose of the Study:
- To compare the dimensions of the pediatric aerodigestive tract with the Small Parts Test Fixture (SPTF).
- To determine if the SPTF adequately captures the size of potential choking hazards in young children.
- To provide data supporting potential modifications to the SPTF for improved child safety.
Main Methods:
- Retrospective review of head/neck CT scans from 106 infants and children (6 months to 6 years).
- Measurement of key aerodigestive tract dimensions, including maxillary incisors to hard palate (MI/HP) and larynx diameter.
- Calculation of specific anatomical ratios to assess dimensional variations.
Main Results:
- A linear trend of increasing dimensions with age was observed in pediatric anatomy.
- The MI/HP length (33.8–45.8 mm) in children under 3 years exceeded the SPTF diameter (31.75 mm).
- No significant gender-based anatomical differences were found across age groups.
Conclusions:
- CT-derived measurements of the pediatric aerodigestive tract are larger than SPTF dimensions.
- The current SPTF may underestimate choking hazards for young children.
- Enlargement of the SPTF is recommended to enhance safety standards for pediatric choking hazards.
Objective:
The Small Parts Test Fixture (SPTF) (16 CFR 1501) was developed from cadavers of young children and foreign body (FB) data. Recent FB studies reveal that the SPTF misses outliers. Computerized tomography (CT) provides detailed dimensional data for young children. Our null hypothesis is that the SPTF (31.75 mm) is smaller than relevant portions of the aerodigestive tract.
Methods:
A 3-year retrospective review (2011-2014) of head/neck CT data for infants and children (N = 106) aged 6 months to 6 years was completed. Six measurements (mm) were recorded: 1) maxillary incisors to posterior edge of hard palate (MI/HP); 2) posterior edge of hard palate to first cervical (C1) vertebra (HP/C1); 3) soft palate to posterior pharyngeal wall; and 4) interpalatine tonsillar distance; 5, 6) larynx diameter, and width. Two ratios were calculated: 1) ratio of lengths (hard palate to soft palate), and 2) laryngeal dimensional ratio.
Results:
A linear trend of increasing dimensions with increased age was noted. The length measured MI/HP best correlates with known data of potential FBs causing injury or death. This MI/HP length can range from 33.8 to 45.8 mm for all children younger than 3 years of age and exceeds the SPTF diameter (31.75 mm). There were no statistical anatomical differences by gender in any of the age groups.
Conclusion:
Computed tomography measurements appear larger than SPTF values developed from cadavers. These CT data support enlargement of the SPTF to enhance safety for choking hazards in children.
Level Of Evidence:
4 Laryngoscope, 129:1468-1476, 2019.
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