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In a retrospective study of children treated in a pediatric emergency department for suspected tracheobronchial foreign bodies from 1997 to 2008, investigators determined the diagnostic test characteristics of standard chest radiographs with and without additional views. In 2003, the institution changed its protocol for additional views for evaluation of suspected foreign bodies from expiratory to decubitus radiographs. Two pediatric radiologists blinded to outcomes identified evidence of foreign bodies (e.g., unilateral emphysema, hyperinflation, localized air trapping).
Of 328 patients (81% <3 years of age), 79 (24%) had foreign bodies (9 in the upper airway) identified by direct laryngoscopy or bronchoscopy. Radiographic evidence of forei…