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A Prospective Study on the Utility of Routine Roentgenograms

E. Martin Caravati, MD; Don L. Bennett, RPh; Newell E. McElwee, PharmD

Am J Dis Child. 1989;143(5):549-551.

Abstract
• It has been recommended that all children with a history of coin ingestion immediately undergo roentgenography to locate the coin, regardless of symptoms. We performed a prospective evaluation of these ingestions to determine the risk of asymptomatic esophageal impaction and the need for routine roentgenography. One hundred sixty-two children (mean ± SD age, 3.6 ± 2.1 years) were evaluated. All were referred for immediate roentgenography after ingestion and followed up daily by telephone for 5 days. Sixty-six patients (41%) did comply and 96 (59%) did not comply with the roentgenogram recommendation. A coin was visualized in the esophagus of 13 patients (20%); 11 were symptomatic and 2 were asymptomatic at the time of ingestion. Symptomatic patients had a 42% risk of a coin later being located in the esophagus compared with a 5% risk for asymptomatic patients. The asymptomatic patients with lodged coins passed them without difficulty after the administration of oral fluids. Nineteen percent of the patients who did not undergo roentgenography were symptomatic and all became asymptomatic within 24 hours of ingestion. There was no difference in morbidity between the group that underwent roentgenography and the group that did not undergo roentgenography at 5 days after ingestion. Children who are asymptomatic at the time of coin ingestion may not need routine roentgenography if they can tolerate oral fluids and telephone follow-up is available.

(AJDC. 1989;143:549-551)

Author Affiliations
From the Intermountain Regional Poison Control Center (Drs Caravati, Bennett, and McElwee) and the Division of Emergency Medicine, University of Utah School of Medicine (Dr Caravati), Salt Lake City, Utah.

Footnotes
Accepted for publication December 19, 1988.

Presented at the American Association of Poison Control Centers, American Academy of Clinical Toxicology, American Board of Medical Toxicology, and Canadian Association of Poison Control Centers Annual Meeting, Baltimore, Md, October 2, 1988.

Reprint requests to Emergency Department, University Hospital, 50 Medical Dr, Salt Lake City, UT 84132 (Dr Caravati).

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