Management of foreign bodies in throat: an emergency department's perspective

Objectives: To review the share of emergency physicians and surgeons in the removal of foreign bodies in throat, and to revisit the concept of home observation and elective endoscopic examination for this group of patients. Design: Retrospective study for a five month period. Setting: Public general hospital with emergency and surgical departments. Population: All patients attending the emergency department from 1st January 1999 to 31st May 1999 with a diagnosis or chief complaint of foreign body in throat or foreign body ingestion. Main outcome measures: Success rate of foreign body retrieval, method of removal, specialty and patient outcome. Results: 79.8% of the foreign bodies were fish bones. Eighty-nine percent foreign bodies was removed by direct laryngoscopy in the emergency department, 6.7% by emergency physicians in the endoscopy unit as outpatients and 4.3% by surgeons after admission. Conclusion: In the absence of frank clinical or radiological sign, a short period of home observation before proceeding to elective oesophagogastro-duodenoscopy (OGD) assessment may be helpful as well as cost-effective. This policy screens out some unnecessary instrumentation, without increasing the rate of complications. As emergency physicians remove the majority of foreign bodies, their expanded involvement on an ambulatory basis is both reasonable and feasible. (Hong Kong j.emerg.med. 2002;9:126-130)