Is There a Need for Repeat Radiologic Examination of Children with Esophageal Coin Foreign Body?

• Published in: Otolaryngology-head and neck surgery 2017-01, Vol.156 (1), p.173-179
• Main Authors: Dedhia, Kavita, Chang, Yue-Fang, Leonardis, Rachel, Chi, David H.
• Format: Article
• Language: English
• Subjects: Child; Child, Preschool; coin foreign body; diagnostic radiation exposure; esophageal foreign body; Esophagus - diagnostic imaging; Female; Foreign Bodies - diagnostic imaging; Foreign Bodies - surgery; Humans; Infant; Male; Needs Assessment; Numismatics; Patient Selection; pediatric anesthesia risk; Radiography, Thoracic; Retrospective Studies
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599816667039

Objectives To determine factors associated with the passage of coins. To determine the need for repeat preoperative chest x-ray (CXR) for esophageal coin foreign body. Setting Academic tertiary care center. Design Case series with chart review. Subjects and Methods Patient information was retrieved from an Institutional Review Board–approved database. We identified 1359 children with esophageal coin foreign bodies from 2001 to 2013. Patients with both initial diagnostic and immediate preoperative CXR were included. Results A total of 406 patients met inclusion criteria. The average age was 47 months (range, 1.8-194 months). On preoperative CXR, the position changed in 29 patients (7%). Age, type of coin, and location of coin were all statistically significant factors affecting the passage of the coin (P < .0001). Coins in the distal esophagus were 9.3 times more likely to pass than coins in the proximal esophagus. The longer the object was in the esophagus, the less likely it was to pass. Conclusions This study characterizes when esophageal coins may pass. Age, type of coin, location of coin at initial x-ray, and length of time are all important considerations to determine if the coin will pass. This information may be used to counsel families about the likelihood of coins to pass and whether repeat x-ray is necessary prior to surgical removal. Additionally, it may be more cost-effective to obtain repeat films in select patients and prevent those from going to the operating theater who are more likely to pass the coin spontaneously.