Successful use of a metal detector in locating coins ingested by children

doi:10.1016/S0022-3476(05)80240-9

The Journal of Pediatrics

Volume 120, Issue 5, May 1992, Pages 752-753

https://doi.org/10.1016/S0022-3476(05)80240-9 Get rights and content

The purpose of this study was to examine the accuracy of a metal detector in locating coins ingested by children. The metal detector correctly identified the presence or absence of coins in 13 patients (93%), as confirmed by radiologic studies.

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Cited by (20)

Utilization of a handheld metal detector protocol to reduce radiation exposure in pediatric patients with esophageal coins
2018, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
It should be noted that the lateral step-off is not consistently seen with some of the newer slimmer designed 3-volt lithium button batteries (i.e. CR2016) and this can appear identical to a coin on lateral x-ray alone [23]. The use of a HHMD for detection of ingested metallic foreign bodies has been described in the literature over the last couple decades [6–22]. Table 2 summarizes several studies that examined the utility of HHMD for coin ingestion.
The primary objective of this study is to assess the utility of a handheld metal detector for identification and surveillance of patients with known esophageal coin ingestion to reduce repeat x-rays and associated radiation exposure.
Prospective study of children presented to the emergency department with esophageal coins confirmed by an initial x-ray were enrolled. The otolaryngology team used the handheld metal detector to detect and localize the coin on patient. If admitted for observation, the metal detector was used to ensure coin persistence prior to going to operating room for removal. No further x-rays were done if same location is confirmed.
A total of 19 patients (10 months-14 years) with 20 esophageal coins were enrolled. 14 patients (73.7%) were initially detected in the emergency department by the metal detector. 11 (58%) asymptomatic patients admitted for period of observation, repeat x-rays were avoided in 10 (90.9%) patients prior to removal in the OR. All proximal esophageal coins were detected with the metal detector. There were 5 (26.3%) patients who failed initial detection of coin, and all of these were in the mid-distal esophageal location with depth from skin >7 cm.
A handheld metal detector is rapid, cost-effective surveillance tool to reduce exposure to radiation from repeated x-rays in patients with esophageal coins. In contrast to all prior published studies, which did not objectively examine depth, the distance of the coin from skin surface appears to be a major limitation. Parents have provided positive feedback on the protocol.
Identification and topographic localization of metallic foreign bodies by metal detector
2004, Journal of Pediatric Surgery
Exact localization of ingested metal objects is necessary to guide therapy. This study prospectively evaluates the accuracy of foreign body (FB) identification and localization by metal detector (MTD) in a systematic topographic fashion.
Patients who presented after an alleged or witnessed metal FB ingestion were scanned with an MTD. In case of a positive signal, the location was recorded in a topographic diagram, and radiographs were obtained. The diagnostic accuracy of the MTD scan for FB identification and topographic localization was determined by χ² analysis, and concordance was calculated by the McNemar test and expressed as κ.
A total of 70 MTD examinations were performed on 65 patients (age 6 months to 16 years); 5 patients were scanned twice on different days. The majority had swallowed coins and button batteries (n = 41). Of these, 29 items were correctly identified, and 11 of 12 were correctly ruled out (coins and button batteries: sensitivity, 100% [95% Confidence Interval 95% to 100%]; specificity, 91.7% [95% CI 76% to 100%], κ = 0.94). When all metallic objects were included, 41 of 46 were correctly identified, and 22 of 24 were correctly ruled out (sensitivity, 89.1% [95% CI 80% to 98%]; specificity, 91.7% [95% CI 81% to 100%], κ = 0.78). Five miscellaneous objects were not identified (sensitivity for items other than coins and button batteries 71% [95% CI 49% to 92%], κ = 0.56). Localization by MTD was correct in 30 of 41 identified objects (73%). The error rates of junior and senior pediatric surgery residents did not differ significantly (P = .82).
Ingested coins and button batteries can be safely and accurately found by metal detector. For these indications, the MTD is a radiation-free diagnostic alternative to conventional radiographs. Other items, however, cannot be ruled out reliably by MTD. In these cases, radiographic imaging is still indicated.
Localizing ingested coins with a metal detector
1999, American Journal of Emergency Medicine
This study was conducted to determine the utility of metal detection in coin localization by inexperienced operators, and determine the rate of spontaneous passage of asymptomatic esophageal coins. All children who presented to the emergency department of an urban children's hospital with a suspected coin ingestion were eligible. Coin location was predicted from metal detector results, while radiographs confirmed location. Asymptomatic patients with esophageal coins were observed for spontaneous passage. Ninety-one children (ages 9 months to 17 years) were prospectively enrolled. The metal detector had a sensitivity of 98% ( $5354$ ) in coin detection and 98% ( $8183$ ) in determining coin location as esophageal. Symptoms were poor predictors of coin location. Six of eight asymptomatic patients with esophageal coins spontaneously passed their coins. These results show that metal detection is a good screening test for coin presence and to determine coin location as esophageal. Spontaneous passage of asymptomatic esophageal coins warrants further study.
Foreign body ingestions in the emergency department: Case reports and review of treatment
1998, Journal of Emergency Medicine
We report a series of alleged ingestions of razor blades and other metal objects by prisoners presenting to an inner city Emergency Department. Fourteen claims of ingestions of razor blades or other metal objects involving eight prisoners occurred in a 5-week period. The motives behind the ingestions varied. Auditory hallucination was the most common reason given for the ingestions. Other motives included efforts to leave prison, depression, and accidental razor blade swallowing. Attempts were made in all patients to verify ingestions by radiograph. Some ingestions could not be confirmed by radiograph and were considered to be factitious. Only 1 of the 14 incidents resulted in hospital admission. All others were either treated in the Emergency Department or the patient was returned to jail with no treatment. No patient had a poor clinical outcome as a result of the ingestion, indicating that diagnostic radiographs and invasive procedures may not always be necessary. A review of treatment of foreign body ingestions is given as well as a summary of the treatment and outcome of these cases.
The role of upper gastrointestinal endoscopy in foreign body removal
1994, Gastrointestinal Endoscopy Clinics of North America
The use of a metal detector for localisation of a metallic foreign body in the floor of the mouth
1993, British Journal of Oral and Maxillofacial Surgery

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Clinical and laboratory observationSuccessful use of a metal detector in locating coins ingested by children

Ann Emerg Med

1989 Annual Report of the American Association of Poison Control Centers National Data Collection System

Am J Emerg Med

Pediatric coin ingestions: a prospective study of coin location and symptoms

Am J Dis Child

Clinical and laboratory observation
Successful use of a metal detector in locating coins ingested by children