Clinical criteria for CT scan evaluation of upper digestive tract fishbone.

OBJECTIVES: To establish clinical criteria for performing computed tomography scan for suspected upper digestive tract fishbone.

METHODS: This is a prospective study of all adult patients referred to the otolaryngology emergency department at our medical center for suspected fishbone in the upper digestive tract after no fishbone was seen on physical examination. The patients were divided into two groups: 1) The first was a high clinical suspicion group, which included patients with at least one of the following criteria: drooling, accumulation of saliva in the sinus piriformis, fever, referral 24 hours after the ingestion with worsening/continuing symptoms, and readmission. These patients underwent nonenhanced CT scan (NECT) of the neck. 2) The second was a low clinical suspicion group, which included patients discharged with no NECT performed. These patients were followed at 1 week and 3 months.

RESULTS: One hundred and fourteen patients were included in the study; the median age was 41 years. Half of the patients arrived at the emergency department within 7 hours. There were no false negatives. The negative predictive value and sensitivity were 100%. Positive predictive value and specificity were 28.5% and 65%, respectively. Referral to the emergency department 24 hours after the ingestion with continuing symptoms had the highest false positive rate.

CONCLUSIONS: Our clinical criteria score for excluding foreign body fishbone in the upper aerodigestive tract was established. According to this score, a NECT can be spared in about 75% of all cases, thus reducing unnecessary ionizing radiation, stay at the emergency department, and costs with a very high NPV of almost 99%.

LEVEL OF EVIDENCE: 4. Laryngoscope, 2467-2472, 2018.