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PO-0285 Identifying Radiologic Signs Of Life-threatening Causes Of Acute Upper Airway Obstruction In Children: Not That Easy!
  1. E Pouliot1,
  2. JA Gagnon1,
  3. S Larose2,
  4. A Lamarre3,
  5. RE Bélanger1
  1. 1Pediatric, CHU de Québec – Pavillon CHUL, Quebec City, Canada
  2. 2Emergency, CHU de Québec – Pavillon CHUL, Quebec City, Canada
  3. 3Radiology, CHU de Québec – Pavillon CHUL, Quebec City, Canada

Abstract

Background Soft tissue neck radiographs (STNRs) are viewed as a helpful tool to investigate causes of acute upper airway obstructions (AUAO) among children. Some radiological findings guide clinicians identifying life-threatening causes of AUAO. Do the clinicians are skilled enough to recognise those signs?

Methods A retrospective study was conduct and the medical files from children aged 0–17 who had a STNR between January 1st2010 and December 31st 2011 in a Canadian university paediatric hospital were reviewed. Those performed in an AUAO context were analysed. Identification by clinicians of significant findings on STNRs related to life-threatening causes of AUAO were compared to radiologists’ reports. Kappa coefficients were determined to describe inter-rater agreement on SNRT findings. The frequency at which SNRTs were described as technically inadequate by radiologists was also analysed.

Results Among 457 STNRs, 11% (n = 52) showed findings of life-threatening causes of AUAO according to clinicians, compared to 17% (n = 77) according to radiologists (global sensibility=35%,specificity=93%; kappa=0.327). Sensibility and specificity differed according to signs evaluated: 26% and 97%, kappa=0.27 for swollen epiglottis/aryepiglottic oedema (n = 23 according to radiologists); 37% and 96%,kappa=0.37 for swelling of the retropharyngeal space (n = 38); 0% and 99% kappa=-0.01 for decrease tracheal diameter/deviation (n = 16); 100% and 99%, kappa=0.86 for the presence of a foreign body (n = 3). Moreover, 15% of SNRTs were described as technically inadequate by radiologists.

Conclusion Identification of life-threatening causes of AUAO on STNRs appears quite challenging for clinicians. SNRTs are technically difficult to perform among children. Importance of STNRs need to be reassessed.

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