Children with a history of coin ingestion should have oesophageal impaction ruled out radiologically
Date First Published:
March 1, 2000
Last Updated:
May 18, 2001
Report by:
Vincent Choudhery, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
Sue Maurice, Manchester Royal Infirmary
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.
Search Details:
({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.
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Coin ingestion: Does every child need a radiograph? Hodge D, Tecklenburg F, Fleisher G. 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 | |
| Pediatric coin ingestion. A prospective study on the utility of routine roentgenograms. Caravati EM, Bennett DL, McElwee NE. 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 | |
| Pediatric coin ingestions. A prospective study of coin location and symptoms. Schunk JE, Corneli H, Bolte R. 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 | |
| Management of pediatric patients who have swallowed foreign objects. Suita S, Ohgami H, Nagasaki A, 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 | |
| Rationalising the management of swallowed coins in children. Stringer MD and Capps SN. 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 | |
| Symptoms and spontaneous passage of esophageal coins. Conners GP, Chamberlain JM, Ochsenschlager DW. 1995 USA. | 73 children with oesophageal coins. | Retrospective survey. | Proportion of oesophageal coins that were asymptomatic | 5 0f 73 (7%) asymptomatic | |
| Esophageal foreign bodies in children: diagnosis, treatment and complications. Macpherson RI, Hill JG, Othersen HB, 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. |
Author Commentary:
All studies show that a significant number of children with oesophageal coins are asymptomatic.
Bottom Line:
All children with a history of coin ingestion should have further investigation to exclude oesophageal impaction.
References:
- Hodge D, Tecklenburg F, Fleisher G.. Coin ingestion: Does every child need a radiograph?
- Caravati EM, Bennett DL, McElwee NE.. Pediatric coin ingestion. A prospective study on the utility of routine roentgenograms.
- Schunk JE, Corneli H, Bolte R.. Pediatric coin ingestions. A prospective study of coin location and symptoms.
- Suita S, Ohgami H, Nagasaki A, et al.. Management of pediatric patients who have swallowed foreign objects.
- Stringer MD and Capps SN.. Rationalising the management of swallowed coins in children.
- Conners GP, Chamberlain JM, Ochsenschlager DW.. Symptoms and spontaneous passage of esophageal coins.
- Macpherson RI, Hill JG, Othersen HB, et al.. Esophageal foreign bodies in children: diagnosis, treatment and complications.