title: Witnessed and unwitnessed esophageal foreign bodies in children.
abstract: OBJECTIVE
  The purpose of this study was to describe the clinical presentation of children with either an unwitnessed or witnessed esophageal foreign body.
  
  
  METHODS
  Retrospective chart review was performed. Patients were identified using ICD-9 code for esophageal foreign body. Clinical data and management techniques, along with complications were abstracted.
  
  
  RESULTS
  For the 5-year period of review, 255 patients were identified with an esophageal foreign body. 214 children had a witnessed ingestion. The mean age of the unwitnessed ingestion group was 2.3 years, compared to 4.6 years for a witnessed ingestion. In both groups, males and females were distributed equally and the most common ingested object was a coin. Bivariate, unadjusted analysis revealed that history of wheeze (OR, 4.35) and fever (OR, 11.15) had the largest association with patients who had an unwitnessed ingestion. Multivariate analysis indicated that any physical findings of wheeze, rhonchi, stridor, or retractions were associated significantly with a diagnosis of an unwitnessed foreign body. Children less than 2 years of age and with a documented fever are also predictive of an unwitnessed ingestion. Eleven children (4.3%) with esophageal abnormalities were also noted to have foreign bodies.
  
  
  CONCLUSIONS
  Children who present to the emergency department two years old and younger, who have a documented fever and with respiratory findings should be considered at risk for having a retained esophageal foreign body. Children with esophageal abnormalities may also be at risk for retained esophageal foreign bodies.
authors.affiliation: Department of Emergency Medicine, Children's Hospital and Clinics of Minnesota, St Paul 55419, USA. Jeffrey.louie@childrenshc.org
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Louie
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.forename: Randy M
authors.initials: RM
authors.lastname: Windreich
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004940:Esophageal Stenosis / Q000453:epidemiology; D004947:Esophagus; D005260:Female; D005502:Food / Q000706:statistics & numerical data; D005547:Foreign Bodies / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018662:Fundoplication / Q000706:statistics & numerical data; D006794:Household Articles / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009717:Numismatics / Q000706:statistics & numerical data; D015143:Philadelphia / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014138:Tracheoesophageal Fistula / Q000453:epidemiology