Conners, Chamberlain, and Ochsenschlager1 add a helpful article to the coin ingestion literature. For asymptomatic children, they propose the following two options: (1) immediate radiography for coin location or (2) delayed radiography up to 24 hours after ingestion (to increase convenience). A third option that was not mentioned is to order a radiograph for asymptomatic children only if they have not passed the coin per rectum by 72 hours following coin ingestion (obviously not acceptable for button batteries, sharp objects, etc). This approach is the most cost-effective. At least 60% of the authors' asymptomatic patients would probably have not needed a radiograph using this approach. I would appreciate the authors' thoughts about this variation on intervention.
One concern about this study is sampling. It only includes children who were referred or walked into the emergency department. Asymptomatic children who were treated by telephone were not included. This may explain
Schmitt BD. Symptoms and Spontaneous Passage of EsophagealCoins. Arch Pediatr Adolesc Med. 1995;149(11):1287. doi:10.1001/archpedi.1995.02170240105027