A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia

Sanchez, M. O., Greer, M. C., Masters, I. B. and Chang, A. B. (2012) A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia. Pediatric Pulmonology, 47 1: 63-67.

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Author Sanchez, M. O.
Greer, M. C.
Masters, I. B.
Chang, A. B.
Title A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia
Journal name Pediatric Pulmonology  (ERA 2012 Listed)    (ERA 2010 Rank B)   Check publisher's open access policy
Publication date 2012-01
Sub-type Article
Year available 2011
DOI 10.1002/ppul.21517
Volume number 47
Issue number 1
ISSN 8755-6863; 1099-0496
Start page 63
End page 67
Total pages 4
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Collection year 2012
Language eng
Formatted abstract Background
Flexible bronchoscopy (FB) is the gold standard method of diagnosing tracheomalacia but it is not always feasible in settings with limited resources. Fluoroscopy is sometimes performed as an alternative diagnostic tool but there are no prospective studies that have evaluated the diagnostic accuracy of airway fluoroscopy for tracheomalacia using a-priori definitions. We determined the sensitivity, specificity, and likelihood predictive ratio of airway fluoroscopy compared with FB in children suspected of having an airway abnormality.

Methods
Airway fluoroscopic examination was undertaken within 2-weeks of a FB in children aged <18-years and reported by a pediatric radiologist blinded to FB data. Fluoroscopic and FB methods and diagnostic criteria were standardized and defined a-priori. Tracheomalacia diagnosed by FB were independently scored (mild, moderate, severe) by 2 pulmonologists in a blinded manner.

Results
In 22 children (median age 33 months, range 1–187) evaluated for airway abnormality, tracheomalacia was found in 21 children at bronchoscopy. Of these, fluoroscopy detected tracheomalacia in five children. Airway fluoroscopy was poorly sensitive (23.8%) but highly specific (100%), positive likelihood ratio was 8.6. However, in moderate-severe tracheomalacia, the sensitivity improved to 57.1% but the specificity reduced (93.3%). The agreement between bronchoscopists for tracheomalacia severity was excellent, weighted kappa 0.74 (95% CI 0.77, 0.98).

Conclusion
Airway fluoroscopy cannot replace FB which remains the tool for definitively diagnosing
airway malacia. However, in absence of other modalities for diagnosis fluoroscopy should be considered in the setting of persistent respiratory symptoms compatible with the clinical picture of tracheomalacia.
Keyword Tracheomalacia
Flexible bronchoscopy
Airway fluoroscopy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 9 AUG 2011

Document type: Journal Article
Sub-type: Article
Collections: Faculty of Health Sciences -- Publications
Official 2012 Collection
School of Medicine Publications
 
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Created: Mon, 19 Dec 2011, 13:22:14 EST by Jane Medhurst on behalf of Queensland Children's Medical Research Institute