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Objectives Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post–coin ingestion. We hypothesized that for children presenting with a clear history of coin ingestion a frontal chest radiograph including the entire esophagus is adequate to guide treatment. Methods We reviewed the clinical history and radiographic surveys of 134 patients presenting with suspected or witnessed coin ingestion to the emergency department of a tertiary care pediatric hospital between January 2012 and June 2016. Patient demographics, presenting symptoms, anatomic coverage of survey, type, number and location of radiopaque foreign bodies, intervention, and follow-up were recorded. Results Coins were identified on radiographic surveys in 109 of 134 patients; 25 of 134 patients had no coin. Of those with coins, none of 109 had coin(s) in the airway, 42 of 109 had coin(s) in the esophagus, and 67 of 109 had coin(s) distal to the esophagus. Of those with esophageal coins, 35 of 42 reported symptoms, 7 of 42 were asymptomatic, 40 of 42 underwent endoscopic coin removal, and 2 of 42 had no intervention. Of 92 of 134 surveyed patients with no coin or coin distal to the esophagus, 30 of 92 reported symptoms, 62 of 92 were asymptomatic, 90 of 92 had no further intervention, and 2 of 92 eventually underwent endoscopic coin removal for specific indications (abdominal pain, delayed passage). When there was no coin found in the esophagus, the negative predictive value for intervention was 97.8%. Conclusions Following a clear history of coin ingestion, a frontal chest radiograph including the entire length of the esophagus provides sufficient information to direct patient management.

ABSTRACT: Paper currency and coins may be a public health risk when associated with the simultaneous handling of food and could lead to the spread of nosocomial infections. Banknotes recovered from hospitals may be highly contaminated by Staphylococcus aureus. Salmonella species, Escherichia coli and S. aureus are commonly isolated from banknotes from food outlets. Laboratory simulations revealed that methicillin-resistant S. aureus can easily survive on coins, whereas E. coli, Salmonella species and viruses, including human influenza virus, Norovirus, Rhinovirus, hepatitis A virus, and Rotavirus, can be transmitted through hand contact. Large-scale, 16S rRNA, metagenomic studies and culturomics have the capacity to dramatically expand the known diversity of bacteria and viruses on money and fomites. This review summarizes the latest research on the potential of paper currency and coins to serve as sources of pathogenic agents.