title: Use of decubitus radiographs in the diagnosis of foreign body aspiration in young children.
abstract: BACKGROUND
  Lateral decubitus radiographs are often obtained in young children with suspected foreign body aspiration. Their usefulness has not been well studied.
  
  
  OBJECTIVE
  To assess the value of decubitus radiographs in detecting foreign body aspiration in young children and compare their value to history and physical examination.
  
  
  METHODS
  Retrospective review of children younger than 4 years with suspected foreign body aspiration who had decubitus radiographs and underwent bronchoscopy over a 5-year period. Patients with proven foreign body aspiration were compared with those without foreign bodies for differences in symptoms, signs, location and character of the foreign body, and the diagnostic value of standard and decubitus chest radiographs.
  
  
  RESULTS
  Twenty-eight of 41 children who underwent bronchoscopy for possible foreign body aspiration had decubitus radiographs. Foreign bodies were identified in 22 patients (79%). A total of 27% of children with foreign body aspiration and 33% of children without a foreign body had suggestive decubitus radiographs (P = not significant). As a measure of detecting foreign body aspiration, positive decubitus radiographs had a sensitivity of 27%, a specificity of 67%, a positive predictive value of 75%, and a negative predictive value of 20%. The odds ratio of finding a foreign body with suggestive decubitus radiographs was 0.75 (95% confidence interval [CI], 0.1-5.2; P = 0.57). Foreign body aspiration was confirmed in 94% of children if there was both a sudden onset of symptoms and a witnessed choking episode (odds ratio, 13.3; 95% confidence interval, 1.3-138.9; P = 0.02).
  
  
  CONCLUSIONS
  Decubitus chest radiographs, at least as routinely performed and interpreted, seem to add little to the evaluation of young children with suspected foreign body aspiration. A history of a witnessed choking episode combined with a sudden onset of respiratory symptoms remains the most important indication for bronchoscopy.
authors.affiliation: Respiratory Center for Children, Morristown Memorial Hospital, Atlantic Health System, Morristown, NJ, USA. assefad@gmail.com
authors.forename: Dagnachew
authors.initials: D
authors.lastname: Assefa
authors.forename: Nikhil
authors.initials: N
authors.lastname: Amin
authors.forename: Gustavo
authors.initials: G
authors.lastname: Stringel
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dozor
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D010367:Arachis; D001980:Bronchi; D001995:Bronchography / Q000706:statistics & numerical data*; D001999:Bronchoscopy; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D010808:Physical Examination; D011237:Predictive Value of Tests; D053120:Respiratory Aspiration; D012135:Respiratory Sounds; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016683:Supine Position; D014132:Trachea / Q000000981:diagnostic imaging*