胸部X线检查(CXR)是评估疑似异物吸入(FBA)儿童的重要工具,尽管在三分之一的病例中它可以被错误地解释为正常。这项研究的目的是评估CXR在疑似FBA住院儿童中的阳性预测值。当被三个学科解释时:儿科肺病学,儿科放射学,和儿科居民。这是一项回顾性研究,包括0-18岁的儿童,被怀疑是FBA,2009年至2020年在一个三级中心。所有患者均接受CXR和柔性/刚性支气管镜检查以明确诊断FBA,相隔一周。每个学科的两名医生解释了CXR,独立。评估了内部评估者和评估者之间的协议。灵敏度,特异性,计算每个学科的曲线下面积(AUC)。四百七十三名儿童被纳入研究,在柔性/刚性支气管镜检查中,使用FBA的175(37%)和不使用FBA的298(63%)。最常见的放射学发现,正如一位儿科肺科医生解释的那样,是单边恶性通货膨胀(47%),不透射线FB(37.6%),肺叶不张(10.3%),单侧过度充气伴肺不张(3.4%),和大叶巩固(1.7%)。评估者的共识范围从儿科肺科医师的0.744(p<0.001)到儿科放射科医师的0.326(p<0.001)。当儿科肺科医师解释时,基于CXR预测FBA的AUC为0.81、0.77和0.7,儿科住院医师,和放射科医生,分别(p<0.001)。
结论:CXR具有较高的阳性预测值,可独立预测儿童FBA;然而,正常CXR不应排除FBA。可预测性在不同学科之间是可变的。
背景:•胸部X光检查是评估疑似异物吸入(FBA)儿童的重要工具。•在三分之一的病例中,胸部X线可以解释为正常。
背景:•胸部X光可独立预测儿童FBA,具有较高的阳性预测值。•胸部X射线预测儿童FBA的能力在儿科住院医师之间有所不同,儿科放射科医生,和儿科肺科医师.
Chest X-ray (CXR) is an important tool in the assessment of children with suspected foreign body aspiration (FBA), although it can falsely be interpreted as normal in one-third of the cases. The aim of this
study is to evaluate the positive predictive value of CXR in children hospitalized with suspected FBA, when interpreted by three disciplines: pediatric pulmonology, pediatric radiology, and pediatric residents. This is a retrospective
study that included children aged 0-18 years, admitted with suspected FBA, between 2009 and 2020 in one tertiary center. All patients underwent CXR and a flexible/rigid bronchoscopy for the definitive diagnosis of FBA, up to 1 week apart. Two physicians from each discipline interpreted the CXR, independently. Intra-raters\' and inter-raters\' agreements were assessed. Sensitivity, specificity, and area under the curve (AUC) were calculated for each discipline. Four hundred seventy-three children were included in the
study, 175 (37%) with FBA and 298 (63%) without FBA on flexible/rigid bronchoscopy. The most common radiological findings, as interpreted by a pediatric pulmonologist, were unilateral hyperinflation (47%), radiopaque FB (37.6%), lobar atelectasis (10.3%), unilateral hyperinflation with atelectasis (3.4%), and lobar consolidation (1.7%). Intra-raters\' agreement ranged from 0.744 (p < 0.001) among pediatric
pulmonologists to 0.326 (p < 0.001) among pediatric radiologists. AUC for predicting FBA based on a CXR was 0.81, 0.77, and 0.7 when interpreted by pediatric
pulmonologists, pediatric residents, and radiologists, respectively (p < 0.001).
CONCLUSIONS: CXR has a high positive predictive value and independently predicts FBA in children; however, normal CXR should not rule out FBA. Predictability is variable among different disciplines.
BACKGROUND: • Chest X-ray is an important tool in the assessment of children with suspected foreign body aspiration (FBA). • Chest X-ray can be interpreted as normal in one-third of the cases.
BACKGROUND: • Chest X-ray independently predicts FBA in children, with a high positive predictive value. • The ability of chest x-ray to predict FBA in children differs between pediatric residents, pediatric radiologists, and pediatric pulmonologists.