Predicting outcome in pediatric coin ingestion

Objective: To determine the relationship between coin size, coin location, patient age, and patient weight and likelihood of coin passage through the esophagus following pediatric coin ingestion. A secondary objective is to t est the hypothesis that coin denomination can be determined based on radiog raphic appearance. Methods: A retrospective review was performed of all chi ldren seen and evaluated for coin ingestion at a single institution over a 25-month period. Outcome measures included the number of coins that were re tained in the esophagus, and the number that passed. Various factors were a ssessed for their predictive value in judging outcome in coin ingestion cas es. Results: Nineteen percent of patients (15/79) in the study passed their ingested coins. Coin denomination could be accurately determined on every patient that had a standard AP or lateral X-ray film. These findings were m arked when compared with the lack of reliability of history in determining coin denomination. Patients who passed coins were as a group older (4.6 vs. 3.2 year, P = 0.04), but did not differ significantly by weight (19.5 vs. 15.4 kg, P = 0.07) from those that retained the coins. Coins located at the gastroesophageal junction had a significantly higher passage rate than coi ns located elsewhere in the esophagus (89 vs. 8.2%, P < 0.01). Coin size wa s not predictive of coin passage (P = 0.7 by <chi>(2)). Conclusions: Radiog raphic assessment of coin denomination is reliable, but in this study could not be used to predict coin passage. Patient age and coin location at the gastroesophageal junction, however, do correlate with this event. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.