Predictive factors associated with spontaneous passage of coins: A ten-year analysis of paediatric coin ingestion in Australia.

OBJECTIVES

Coins are the commonest foreign body ingested in paediatric populations. Although most ingested coins are either spontaneously passed or retrieved with medical intervention without serious consequence, there is potential for serious morbidity and mortality related to paediatric coin ingestion. We performed a 10-year retrospective review of Australian denomination coin ingestion at a tertiary paediatric hospital in Sydney, Australia. We attempted to determine whether a relationship exists between coin size, patient age, coin ingestion and spontaneous passage.

METHODS

Hospital records of all children presenting in a 10-year period to a paediatric tertiary care centre for coin ingestion were reviewed. Demographic information, coin denomination, previous history, symptoms, investigations, management, outcome and complications were recorded.

RESULTS

241 cases were identified. The majority (55%) of cases occurred in children ≤3 years of age (range 7 months-11 years, mean 3.39 years). The most common location where coins were identified was in the proximal third of the oesophagus or at the cricopharyngeus (65%). Spontaneous passage occurred in 84 cases (34.9%) while 167 cases (69.3%) required intervention. Children ≤3 years were more likely to ingest small coins (<22 mm) (OR: 2.44; 1.39-4.17) and children >3 years were more likely to ingest larger coins (22-26 mm) (OR: 2.17; 1.39-4.35).

CONCLUSIONS

Coin size, coin weight and age of the child appear to be predictors for both likelihood of ingestion and spontaneous passage in paediatric coin ingestion cases. A child with minimal symptoms, witnessed ingestion and radiographic identification of the coin in the lower oesophagus or more distal can often be safety observed for up to 24 h in anticipation of spontaneous passage.