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ACR Appropriateness Criteria® Ingested or Aspirated Foreign Body-Child.

, Mariana L Meyers1, Michael M Moore2

  • 1Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.

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Summary

Pediatric foreign body ingestion or aspiration requires specific imaging guidelines. This document outlines appropriate imaging choices for ingested or aspirated foreign bodies (FBs) based on clinical suspicion and prior imaging results.

Keywords:
AUCAppropriateness Criteriaappropriate use criteriaaspiration/aspiratedchildforeign body/bodiesingestion/ingestedpediatricwater beads

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Area of Science:

  • Pediatric Radiology
  • Medical Imaging Guidelines
  • Emergency Medicine

Background:

  • Foreign body (FB) ingestion or aspiration is a frequent cause of pediatric emergency department visits.
  • Timely and accurate diagnosis is crucial for effective management of pediatric foreign bodies.

Purpose of the Study:

  • To provide evidence-based imaging recommendations for pediatric foreign body ingestion and aspiration.
  • To outline appropriate imaging strategies based on clinical presentation and initial findings.

Main Methods:

  • Development of three variants based on clinical suspicion (ingested vs. aspirated FB) and initial imaging results.
  • Systematic analysis of medical literature using established methodologies like GRADE.
  • Expert consensus and the RAND/UCLA Appropriateness Method for guideline formulation.

Main Results:

  • Variant 1 (suspected FB): Radiographs of the neck, chest, abdomen, and pelvis are generally appropriate; low-dose noncontrast chest CT may be used for radiolucent FBs.
  • Variant 2 (ingested FB, negative initial radiographs): Chest CT without contrast is usually appropriate; fluoroscopic esophagram or CT abdomen/pelvis may be considered. Abdomen ultrasound is helpful for water bead ingestion.
  • Variant 3 (aspirated FB, negative initial radiographs): CT chest without contrast is usually appropriate; decubitus chest radiographs and fluoroscopy are generally not appropriate.

Conclusions:

  • The American College of Radiology Appropriateness Criteria provide a framework for selecting optimal imaging in pediatric FB cases.
  • Imaging choices should be tailored to the suspected FB location and patient presentation.
  • These guidelines aim to ensure appropriate use of imaging resources in pediatric foreign body emergencies.