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Three Part Question

In [children who have swallowed coins] is [history and examination] accurate at [ruling out oesophageal impaction]?

Clinical Scenario

A 3 year old boy is brought into the Emergency Department by his mother. She says that he swallowed a coin 2 hours earlier. The boy is asymptomatic. You wonder whether a chest x-ray should be done to exclude oesophageal impaction.

Search Strategy

Medline 1966-12/99 using the OVID interface.
({exp numismatics OR coin$.mp OR exp foreign bodies OR foreign body.mp OR foreign bodies.mp} AND {exp pediatrics OR pediatric$.mp OR paediatric$.mp OR child$.mp} AND {ingest$.mp OR swallow$.mp OR exp esophagus OR esophagus.mp OR esophageal.mp OR oesophagus.mp OR oesophageal.mp}) LIMIT to human AND english.

Search Outcome

435 papers found of which 428 were irrelevant or of insufficient quality. The remaining 7 papers are shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Hodge D, et al. 1985. USA.	92 children attending an emergency department with a history of coin ingestion. 25 oesophageal coins.	Retrospective survey.	Proportion of oesophageal coins that were asymptomatic	11 of 25 (44%) asymptomatic
Caravati EM, et al. 1989. USA.	66 children attending for chest x-ray with a history of coin ingestion. 11 oesophageal coins.	Prospective survey.	Proportion of oesophageal coins that were asymptomatic	2 of 11 (18%) asymptommatic
Schunk JE, et al. 1989. USA.	52 children attending an emergency department with a history of coin ingestion. 30 oesophageal coins.	Prospective survey.	Proportion of oesophageal coins that were asymptomatic	9 of 30 (32%) asymptomatic
Suita S, et al. 1989. Japan.	141 children attending an emergency department with a history of ingested foreign body. 11 oesophageal coins.	Retrospective survey.	Proportion of oesophageal coins that were asymptomatic	7 of 11 (64%) asymptomatic
Stringer MD, et al. 1991. UK.	50 children with a history of coin ingestion. 15 oesophageal coins.	Retrospective survey.	Proportion of oesophageal coins that were asymptomatic	9 of 15 (60%) asymptomatic
Conners GP, et al. 1995. USA.	73 children with oesophageal coins.	Retrospective survey.	Proportion of oesophageal coins that were asymptomatic	5 0f 73 (7%) asymptomatic
Macpherson RI, et al. 1996. USA.	118 children with 123 episodes of retained oesophageal foreign bodies. 85 oesophageal coins.	Retrospective survey.	Proportion of oesophageal foreign bodies that were asymptomatic	20% asymptomatic	Not only coins studied and results for coins alone not clear.

Comment(s)

All studies show that a significant number of children with oesophageal coins are asymptomatic.

Clinical Bottom Line

All children with a history of coin ingestion should have further investigation to exclude oesophageal impaction.

References

1. Hodge D, Tecklenburg F, Fleisher G. Coin ingestion: Does every child need a radiograph? Ann Emerg Med 1985;14:443-6.
2. Caravati EM, Bennett DL, McElwee NE. Pediatric coin ingestion. A prospective study on the utility of routine roentgenograms. Am J Dis Child 1989;143:549-51.
3. Schunk JE, Corneli H, Bolte R. Pediatric coin ingestions. A prospective study of coin location and symptoms. Am J Dis Child 1989;143:546-8.
4. Suita S, Ohgami H, Nagasaki A, et al. Management of pediatric patients who have swallowed foreign objects. Am Surg 1989;55:585-90.
5. Stringer MD and Capps SN. Rationalising the management of swallowed coins in children. BMJ 1991;302:1321-2.
6. Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med 1995;149:36-9.
7. Macpherson RI, Hill JG, Othersen HB, et al. Esophageal foreign bodies in children: diagnosis, treatment and complications. American Journal of Roentgenology 1996;166:919-24.