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November 1995

Symptoms and Spontaneous Passage of EsophagealCoins-Reply

Author Affiliations

Department of Emergency Medicine University of Rochester Medical Center 601 Elmwood Ave Box 655 Rochester, NY 14642
Washington, DC

Arch Pediatr Adolesc Med. 1995;149(11):1287. doi:10.1001/archpedi.1995.02170240105028

We appreciate Dr Schmitt's interest in our recent article.1 As we noted, our data were retrospectively collected from the charts of all patients seen in a pediatric emergency department over an 18-month period. As Dr Schmitt notes and Paul et al2 have shown, this is a somewhat different population from those patients managed exclusively in a primary care setting. Because of these differences, we were unable to formally assess the cost-effectiveness of obtaining a radiograph for most asymptomatic children who have swallowed a coin. However, since an asymptomatic child may have an esophageal coin, we concluded that the safest approach would be to obtain a radiograph after 24 hours, allowing the child sufficient time to possibly pass the coin while staying within the 24-hour period during which esophageal mucosal inflammation has been shown to be minimal.3 Although waiting 72 hours before ordering a radiograph to