• Karthik Devarajan, Stanley Voigt, Sunil Shroff, Scott G Weiner, and Richard O Wein.
• Tufts University School of Medicine/Heller School for Social Policy and Management of Brandeis University, Boston, Massachusetts, USA Karthik.devarajan@tufts.edu.
• Ann Oto Rhinol Laryn. 2015 Aug 1;124(8):614-21.

ObjectivesIn the emergency department, fish and chicken bone impactions are typically evaluated with screening x-rays. We sought to determine whether this modality ultimately improves system outcomes, including length of stay (LOS), cost, and radiation dosage.MethodsWe reviewed patients ≥ 18 years old presenting to an urban academic emergency department over a 4-year period who received a screening soft-tissue x-ray to determine the presence of a retained fish or chicken bone. We calculated the diagnostic accuracy of x-ray and computed tomography (CT) evaluations, respectively, in addition to system outcomes.ResultsTwenty-seven of the 78 patients included for analysis were ultimately positive for bone impaction. Initial x-ray interpretations demonstrated a sensitivity of 24.0% (95% CI, 9.4%-45.1%) and a specificity of 90.0% (95% CI, 78.2%-96.7%). However, initial CT interpretation (ie, a preliminary read from on-call residents) demonstrated a sensitivity of 75% (95% CI, 19.4%-99.4%) and a specificity of 100% (95% CI, 59.0%-100%). LOS, cost, and radiation dosage were not significantly different between patients who ultimately had true bone impactions and those who did not (P > .05).ConclusionsX-rays are poor screening tools in determining fish or chicken bone impactions with poor diagnostic and system utility. Further studies should be performed to evaluate the role of a low-radiation CT screen.© The Author(s) 2015.

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