Pediatric coin ingestion. A prospective study on the utility of routine roentgenograms
E. M. Caravati, D. L. Bennett and N. E. McElwee
Intermountain Regional Poison Control Center, University of Utah School of Medicine, Salt Lake City.
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.
