The role of airway fluoroscopy in the evaluation of children with stridor.

OBJECTIVE To determine the sensitivity and specificity of airway fluoroscopy in the diagnosis of pediatric laryngotracheal abnormalities. DESIGN Retrospective chart review. SETTING Tertiary care children's hospital. PATIENTS Thirty-nine children, with a mean age of 18 months at the time of evaluation, were evaluated for stridor. MAIN OUTCOME MEASURES Diagnoses made by airway fluoroscopy and endoscopy. The medical records of patients who had undergone both airway fluoroscopy and airway endoscopy for the evaluation of stridor over a 5-year period were reviewed. The sensitivity, specificity, and positive and negative predictive values of airway fluoroscopy in the diagnosis of laryngomalacia, tracheomalacia, airway stenosis at any level, and airway mass lesions were determined using endoscopic evaluation as the "gold standard." RESULTS Twenty-three of 39 patients (59%) received a different diagnosis by airway endoscopy than by airway fluoroscopy. The sensitivity of airway fluoroscopy in the diagnosis of laryngomalacia, tracheomalacia, airway stenosis, and an airway mass was 27%, 20%, 69%, and 43%, respectively. The specificity for the same diagnoses was 100%, 94%, 100%, and 100%, respectively. CONCLUSIONS Airway fluoroscopy appears to be reliable in the diagnosis of laryngomalacia, tracheomalacia, airway stenosis, and airway masses because of its high specificity. However, its sensitivity in detecting these common causes of stridor is poor. Negative fluoroscopic study results require further diagnostic evaluation if the clinical indication exists; therefore, the value of fluoroscopy as a screening tool remains uncertain.