ACR Appropriateness Criteria® Ingested or Aspirated Foreign Body-Child.

Abstract

Ingestion or aspiration of foreign bodies (FB) is a common reason for pediatric emergency department visits. Three variants were developed: 1) Variant 1 (suspect ingested or aspirated FB, initial imaging), neck, chest, abdomen, and pelvis radiographs are usually appropriate to identify the presence and location of a swallowed or inhaled FB. Low-dose noncontrast chest CT may also be appropriate when there is high suspicion for radiolucent FB; 2) Variant 2 (suspect ingested FB, initial radiographs negative, next imaging study), chest CT without contrast is usually appropriate, although fluoroscopic esophagram or CT abdomen and pelvis may be appropriate. If known ingested water beads, abdomen ultrasound may be helpful; 3) Variant 3 (suspect aspirated FB, initial radiographs negative, next imaging study), CT chest without contrast is usually appropriate, whereas decubitus chest radiographs and fluoroscopy studies are usually not appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.