Diagnostic performance of conventional x-ray for detecting foreign bodies in the upper digestive tract: A systematic review and diagnostic meta-analysis

Ta Wei Yang, Yi Chung Yu, Yen Yue Lin, Shih Chang Hsu, Karen Chia Wen Chu, Chin Wang Hsu, Chyi Huey Bai, Cheng Kuang Chang, Yuan Pin Hsu

Research output: Contribution to journalArticlepeer-review

Abstract

Foreign body (FB) ingestion is a common clinical problem in acute settings. Detecting FBs in the upper digestive tract is challenging. The conventional X-ray is usually the first-line imaging tool to detect FBs. However, its diagnostic performance is inconsistent in the literature. In this study, we performed a systematic review and meta-analysis to determine the diagnostic performance of the conventional X-ray for detecting FBs in the upper digestive tract. We conducted a systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus until 1 August 2020. Prospective or retrospective studies investigating the diagnostic accuracy of conventional X-rays for detecting FBs in the upper digestive tract in patients of all ages were included. The Quality Assessment of Studies of Diagnostic Accuracy-2 tool was used to review the quality of included studies. We used a bivariate random-effects model to calculate diagnostic accuracy parameters. Heterogeneity was assessed using I2 statistics. We included 17 studies (n = 4809) in the meta-analysis. Of the 17 studies, most studies were rated as having a high risk of bias. Conventional X-rays had a pooled sensitivity of 0.58 (95% confidence interval [CI] = 0.36–0.77, I2 = 98.52) and a pooled specificity of 0.94 (95% CI = 0.87–0.98, I2 = 94.49) for detecting FBs in the upper digestive tract. The heterogeneity was considerable. The area under the summary receiver operating characteristic curve was 0.91 (95% CI = 0.88–0.93). Deek’s funnel plot asymmetry test results revealed no significant publication bias (p = 0.41). The overall sensitivity and specificity of conventional X-rays were low and high, respectively, for detecting FBs in the upper digestive tract. Hence, conventional X-rays to exclude patients without upper FBs in the digestive tract are not recommended. Further imaging or endoscopic examinations should be performed for at-risk patients.

Original languageEnglish
Article number790
JournalDiagnostics
Volume11
Issue number5
DOIs
Publication statusPublished - May 2021

Keywords

  • Fish bone
  • Foreign bodies
  • Plain radiography
  • Upper digestive tract

ASJC Scopus subject areas

  • Clinical Biochemistry

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