title: Diagnosing Fish Bone and Chicken Bone Impactions in the Emergency Department Setting: Measuring the System Utility of the Plain Film Screen.
abstract: OBJECTIVE
  In the emergency department, fish and chicken bone impactions are typically evaluated with screening x-rays. We sought to determine whether this modality ultimately improves system outcomes, including length of stay (LOS), cost, and radiation dosage.
  
  
  METHODS
  We reviewed patients ≥ 18 years old presenting to an urban academic emergency department over a 4-year period who received a screening soft-tissue x-ray to determine the presence of a retained fish or chicken bone. We calculated the diagnostic accuracy of x-ray and computed tomography (CT) evaluations, respectively, in addition to system outcomes.
  
  
  RESULTS
  Twenty-seven of the 78 patients included for analysis were ultimately positive for bone impaction. Initial x-ray interpretations demonstrated a sensitivity of 24.0% (95% CI, 9.4%-45.1%) and a specificity of 90.0% (95% CI, 78.2%-96.7%). However, initial CT interpretation (ie, a preliminary read from on-call residents) demonstrated a sensitivity of 75% (95% CI, 19.4%-99.4%) and a specificity of 100% (95% CI, 59.0%-100%). LOS, cost, and radiation dosage were not significantly different between patients who ultimately had true bone impactions and those who did not (P > .05).
  
  
  CONCLUSIONS
  X-rays are poor screening tools in determining fish or chicken bone impactions with poor diagnostic and system utility. Further studies should be performed to evaluate the role of a low-radiation CT screen.
authors.affiliation: Tufts University School of Medicine/Heller School for Social Policy and Management of Brandeis University, Boston, Massachusetts, USA Karthik.devarajan@tufts.edu.
authors.forename: Karthik
authors.initials: K
authors.lastname: Devarajan
authors.affiliation: Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Voigt
authors.affiliation: Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Shroff
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Scott G
authors.initials: SG
authors.lastname: Weiner
authors.affiliation: Department of Otolaryngology, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Wein
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001842:Bone and Bones; D002645:Chickens; D003954:Diagnostic Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005399:Fishes; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011829:Radiation Dosage; D011859:Radiography / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards; D014481:United States
keywords: bone impaction; computed tomography; cost; length of stay; radiation; x-ray