Examining the Utility of Lateral Neck X-Rays in Pediatric Otolaryngology

The utility of lateral neck X-rays is unclear in pediatric otolaryngology. Past research showed that lateral neck X-ray did not change treatment decisions for children with suspected foreign body aspiration. This study examines the utility of lateral neck X-ray for patients also receiving otolaryngology consults for any indication.

This is a retrospective chart review of pediatric patients between 2012 and 2022 who received a lateral neck X-ray for any indication and an otolaryngology consultation at a tertiary pediatric hospital. X-ray indication, diagnosis, and influence on interventional decisions were recorded from chart review.

Of patients who received lateral neck X-rays, 494 patients (8.17%) also had an otolaryngology consult. Average patient age was 3.15 years. The most common indications for X-ray were foreign body aspiration (22%), croup (21%), breathing difficulties (20%), abscess or retropharyngeal infection (7%), and upper airway obstruction (5%). Lateral neck X-ray changed the Otolaryngologist's decision in 15% of patients. Intervention occurred in 25% of Otolaryngology consults, and this decision was never based on the X-ray.

Lateral neck X-ray is unlikely to change Otolaryngology management. It is least indicated in patients presenting with concern of abscess and foreign body aspiration. Consultation with Otolaryngology before ordering diagnostic testing for those presenting with breathing difficulties, croup and upper airway obstruction may have cost savings and prevent unnecessary radiation exposure.