Hodge D, Tecklenburg F, Fleisher G
Ann Emerg Med. 1985 May;14(5):443-6. doi: 10.1016/s0196-0644(85)80289-4.
We studied 80 children who presented to the emergency department (ED) with a complaint of coin ingestion to determine whether radiographs are necessary in all situations and to determine which symptoms or signs are predictive of esophageal coins. Radiographs were considered positive if the coin was in the esophagus. Radiographs were positive in 25 (31%) of patients, of whom 11 (14%) had no symptoms or signs in the ED. Fifty-five (69%) of the 80 patients had subdiaphragmatic foreign bodies (44 [55%]), or no foreign bodies (11 [14%]) seen on films. Fourteen (18%) of the children required removal of the coin. Variables correlating with positive radiograph, in order of significance, included localization, choking at ingestion, drooling in the ED, vomiting, and chest pain (P less than .05). Symptom type was predictive of radiographic findings, and it may be predictive of need for removal. All 14 patients with symptoms or signs in the ED had positive films, as compared to 11 of 66 (16.6%) with no symptoms (chi square = 33.555; P less than .001). Although this relationship is significant, the finding of esophageal foreign body in 17% of patients with no symptoms leads us to recommend that all patients have a chest radiograph if coin ingestion is suspected.
我们研究了80名因吞食硬币而到急诊科就诊的儿童，以确定在所有情况下是否都需要进行X光检查，并确定哪些症状或体征可预测食管内有硬币。如果硬币位于食管内，则X光检查被视为阳性。25名（31%）患者的X光检查呈阳性，其中11名（14%）在急诊科时没有症状或体征。80名患者中有55名（69%）在X光片上显示有膈下异物（44名[55%]）或没有异物（11名[14%]）。14名（18%）儿童需要取出硬币。与X光检查阳性相关的变量，按重要性排序，包括硬币位置、吞食时窒息、在急诊科流口水、呕吐和胸痛（P<0.05）。症状类型可预测X光检查结果，也可能预测是否需要取出硬币。在急诊科有症状或体征的所有14名患者的X光片均为阳性，相比之下，66名无症状患者中有11名（16.6%）的X光片为阳性（卡方检验=33.555；P<0.001）。尽管这种关系具有统计学意义，但17%无症状患者中发现食管异物这一情况让我们建议，如果怀疑有硬币吞食，所有患者都应进行胸部X光检查。
