Battery ingestions in children: Variations in care and development of a clinical algorithm.
PURPOSE: To review current management and outcomes of ingested batteries and develop a clinical management algorithm.
METHODS: Children/2011 and 9/2016 at two tertiary care children's hospitals were reviewed. Demographics, imaging, management and outcomes were analyzed using descriptive statistics, Chi-square and Wilcoxon Rank-sum tests.
RESULTS: There were 180 battery ingestions. The median age was 3.9 (range 0.7-18) years, with 78 (43%) males. The most common symptoms were abdominal pain (17%) and nausea/vomiting (14%). Diagnosis was confirmed with plain radiographs in 170 (94%) patients. Locations on imaging were: stomach (37%), small bowel (24%), esophagus (18%), colon (11%), and non-specific location past the gastroesophageal junction (9%). Treatment was dictated by five different subspecialties including surgery (35%), gastroenterology (25%), emergency medicine (19%), primary care/emergency with a consulting service (13%), and otolaryngology (8%). All esophageal batteries (n=33) had an intervention. Interventions included fluoroscopic balloon extraction (6 attempted, 33% retrieval rate), rigid esophagoscopy (26 attempted, 96% retrieval rate), and EGD (6 attempted, 83% retrieval rate). For batteries distal to the gastroesophageal junction 16 (11%) patients had an intervention. Interventions included EGD (13 patients, 69% retrieval), colonoscopy (1 patient, successful retrieval), and abdominal surgery in two patients.
CONCLUSION: Isolated batteries that pass the gastroesophageal junction rarely require intervention and can be managed conservatively. Given the variability in managing these patients, we developed an evidence based algorithm.
LEVEL OF EVIDENCE: Level 2.
STUDY TYPE: Retrospective Study.
Journal of pediatric surgery
Adolescent; Algorithms; Child; Child, Preschool; Electric Power Supplies; Endoscopy, Gastrointestinal; Female; Foreign Bodies; Gastrointestinal Tract; Humans; Infant; Laparotomy; Male; Retrospective Studies
Swallowed Objects; Foreign body ingestion; battery ingestion; standardized protocols
Rosenfeld, E. H., Sola, R., Yu, Y., St Peter, S. D., Shah, S. R. Battery ingestions in children: Variations in care and development of a clinical algorithm. Journal of pediatric surgery 53, 1537-1541 (2018).