title: Diagnosis of Pediatric Foreign Body Ingestion: Clinical Presentation, Physical Examination, and Radiologic Findings.
abstract: OBJECTIVE
  (1) To describe clinical and radiologic findings in patients with esophageal foreign bodies. (2) To examine the sensitivity and specificity of history, physical examination, and radiologic studies in children with suspected foreign body ingestion.
  
  
  METHODS
  A retrospective cohort study was performed evaluating all children who underwent esophagoscopy for suspected foreign body ingestion at our institution from 2006 to 2013.
  
  
  RESULTS
  Five hundred forty-three patients were included (54% male). Average age was 4.7 years (SD = 4.1 years). Foreign bodies were identified on esophagoscopy in 497 cases (92%). Ingestion was witnessed in 23% of cases. Most common presenting symptoms were choking/gagging (49%), vomiting (47%), and dysphagia/odynophagia (42%). Most patients with foreign bodies had a normal exam (76%). Most foreign bodies were radiopaque (83%). In 59% of patients with normal chest radiographs, a foreign body was present. Sensitivity and specificity of 1 or more findings on history, physical examination, and imaging were 99% and 0%, 21% and 76%, and 83% and 100%, respectively.
  
  
  CONCLUSIONS
  Most patients with esophageal foreign bodies are symptomatic. Although many patients will have a normal physical examination, an abnormal exam should increase suspicion for a foreign body. Most esophageal foreign bodies are radiopaque, but a normal chest radiograph cannot rule out a foreign body.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh School of Medicine; UPMC MOntefiore Hospital N-715; Pittsburgh, Pennsylvania, USA.
authors.forename: Jacquelyn R
authors.initials: JR
authors.lastname: Sink
authors.affiliation: Department of Otolaryngology; Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Kitsko
authors.affiliation: Department of Otolaryngology; Texas Children's Hospital; Baylor College of Medicine; Houston, TX, USA.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Mehta
authors.affiliation: Department of Otolaryngology; Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Georg
authors.affiliation: Department of Otolaryngology; Children's Hospital of Pittsburgh of UPMC; University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, USA jeffrey.simons@chp.edu.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003680:Deglutition Disorders; D004435:Eating; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005683:Gagging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014839:Vomiting
keywords: child; esophagoscopy; esophagus; foreign bodies/diagnosis; foreign bodies/therapy; pediatric; preschool