Many centres would still use rigid bronchoscopy as the gold standard for possible foreign body aspiration (FBA) in children. Evidence is growing that CT scanning in these situations is a reliable alternative, especially as rigid bronchoscopy (RB) still carries a not insignificant risk. This group from France evaluated their six year experience of CT scanning for all suspected FBA attending the emergency department. Either an emergency doctor or an otolaryngologist made the diagnosis. It was performed regardless of physical exam or CXR findings, however unstable patients were transferred straight to the operating room for bronchoscopy.
Two hundred children underwent CT scanning, none requiring GA, but midazolam sedation was used when required. Low dose, non-contrast CT was used. Of the 200 cases, 132 (66%) of the CT scans were considered normal. Twenty-seven of these patients underwent RB anyway as clinical suspicion was still strong. All of these were negative.
One patient who had a normal CT and no RB presented three months later with asthma type symptoms and a CT at that time showed a FB which was subsequently removed. It was unclear whether this was a new episode, which the authors think it was, however they treated this patient as a false negative for statistical purposes. The 68 patients who had a pathological CT all had RB, and 59 of them were found to have a FB. Five patients (8.3%) were asymptomatic and had a normal chest X-ray, but due to an abnormal CT went ahead for RB and were found to have a FB. Although the authors admit that monitoring of the parameters during RB were incomplete, they did have one child with a negative RB who had laryngospasm and bradycardia during the procedure and had a hospital admission for two days as a result. The results from this study show a sensitivity of CT scanning of 98.3% and specificity of 93.6%. This is a tool that will likely become more valuable as pressure on operating space intensifies, however the jury is still out as to whether it will become the gold standard.