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Rationalising the management of swallowed coins in children
1Department of Paediatric Surgery, Queen Mary's Hospital for Children, Carshalton, Surrey.
Insights
Management of swallowed coins in children often involves unnecessary radiation exposure and surgical intervention. A standardized approach, typically requiring only a single chest and neck radiograph, is recommended for pediatric coin ingestion.
Area of Science:
- Pediatric Medicine
- Radiology
- Surgical Management
Background:
- Swallowed coins are a common pediatric emergency.
- Current management protocols for pediatric coin ingestion vary.
- Over-investigation and overtreatment can lead to increased risks.
Purpose of the Study:
- To evaluate the current management strategies for children who swallowed coins.
- To identify areas for improvement in the diagnostic and treatment pathways.
- To establish a consensus for optimal coin ingestion management in pediatric patients.
Main Methods:
- Retrospective study of medical records from three hospital departments (Accident & Emergency, Radiology, Operating Theatre).
- Inclusion of 50 children diagnosed with coin ingestion between 1986 and 1990.
- Analysis of radiological findings, coin location, presenting symptoms, and interventions performed.
Main Results:
- Coin ingestion was recorded in 50 children over a four-year period.
- Radiological assessment varied, with 40 children receiving both chest and abdominal radiographs.
- Coins were found in the esophagus (15 children, 6 symptomatic) and below the cardia (26 children, asymptomatic); 9 had no coin visualized. Eleven children had further abdominal radiographs despite lacking symptoms; one underwent gastric coin removal.
Conclusions:
- Current management practices expose children to excessive radiation and surgical procedures.
- A need exists for a unified consensus on managing swallowed coins in pediatric populations.
- The majority of cases can be effectively managed with a single chest and neck radiograph, reserving further intervention for symptomatic or complicated cases.
Objective:
To assess the management of swallowed coins in children and identify aspects that could be improved.
Design:
Study of records of three hospital departments for 1986-90.
Setting:
Accident and emergency, radiology, and operating theatre departments in a children's hospital.
Subjects:
50 children reported to have ingested coins.
Main Outcome Measures:
Radiological investigations performed, position of coin, symptoms of child, and surgical intervention.
Results:
50 children were recorded to have swallowed coins during 1986-90. Five children had only chest radiography, five only abdominal radiography, and 40 had both. A coin was detected in the oesophagus in 15 children, six of whom had symptoms, and below the cardia in 26, none of whom had symptoms; no coin was seen in nine children. Eleven children had further abdominal radiographs despite the absence of gastrointestinal symptoms; one child had a coin removed from the stomach.
Conclusions:
Children are being unnecessarily exposed to radiation and surgical intervention, and a consensus on management of swallowed coins is needed. Most children require only a single chest and neck radiograph.