I read, with great interest, the article by Conner et al1 in the January 1995 issue of the Archives. The authors are quite correct in stating that the issue of what to do with children who swallow coins is one of great controversy and anxiety. However, their study suffers from some errors of similar studies. It is, essentially, a study of patients who appear in emergency departments. Thus, for whatever reason, even the asymptomatic patients were self-selected to go to emergency departments. Therefore, I do have a problem looking at these data as if they have global importance. The data they cite from other studies show a great variety of results in describing asymptomatic children proven to have coins in the esophagus. In their article, two of 73 children who appeared in emergency departments after ingesting coins were asymptomatic and had radiographic evidence of an esophageal coin. One of
Marcus SM. Symptoms and Spontaneous Passage of Esophageal Coins. Arch Pediatr Adolesc Med. 1995;149(11):1285–1286. doi:10.1001/archpedi.1995.02170240103024
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