Submitting/Presenting Author

James Fraser, Children's Mercy HospitalFollow

Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Shawn D. St. Peter, MD

Start Date

11-5-2021 11:30 AM

End Date

11-5-2021 1:30 PM

Presentation Type

Poster Presentation

Description

Background/Objectives/Goal: Complications from battery ingestion in the pediatric population are becoming more severe due to the emergence of stronger and smaller batteries. We previously established a symptom-focused, evidence-based algorithm for battery ingestion and seek to evaluate this protocol to investigate its safety and potential cost benefit. (Figure 1)

Methods/Design: Following IRB approval, all radiographs performed for foreign body ingestion between 2017-2020 were reviewed. All button battery ingestions were included to evaluate an institutional symptom-based algorithm emphasizing observation over intervention.

Results: Review of 2,237 foreign bodies series demonstrated 44 button battery ingestions. Median age at ingestion was 3.8 years [2.5,5.2]. Locations of batteries on presentation were esophagus (14%), stomach (64%), small bowel (14%), and colon (9%). All esophageal batteries (n=6) were managed per protocol with immediate endoscopic retrieval. Twentyeight patients presented with gastric batteries; ten (36%) were not managed per protocol. All ten patients were asymptomatic on presentation; however, admitted for observation and serial x-rays. Of these ten patients, six had imaging within twelve hours of presentation that demonstrated transpyloric migration of batteries, and four underwent EGD, with 50% retrieval rate and migration of the battery by the time of intervention. All small bowel batteries (n=6) and three of four asymptomatic colon batteries were managed per protocol; one patient had imaging within 12 hours that demonstrated passage of the battery. In total, eleven of forty-four patients (25%) were not managed per protocol; however, if adherent to our protocol would not require admission, short interval imaging, or intervention and provide a median cost reduction of $1,553 [$152, $3,938] (p=0.04) with identical outcomes.

Conclusions: Adherence to a symptom-based protocol for conservative management of battery ingestions beyond the gastroesophageal junction is safe with minimal complications or need for admission, serial imaging, or intervention, and may provide potential cost benefit.

Comments

Abstract Only.

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May 11th, 11:30 AM May 11th, 1:30 PM

Evaluation Of A Symptom-based Algorithm For Managing Battery Ingestions In Children

Background/Objectives/Goal: Complications from battery ingestion in the pediatric population are becoming more severe due to the emergence of stronger and smaller batteries. We previously established a symptom-focused, evidence-based algorithm for battery ingestion and seek to evaluate this protocol to investigate its safety and potential cost benefit. (Figure 1)

Methods/Design: Following IRB approval, all radiographs performed for foreign body ingestion between 2017-2020 were reviewed. All button battery ingestions were included to evaluate an institutional symptom-based algorithm emphasizing observation over intervention.

Results: Review of 2,237 foreign bodies series demonstrated 44 button battery ingestions. Median age at ingestion was 3.8 years [2.5,5.2]. Locations of batteries on presentation were esophagus (14%), stomach (64%), small bowel (14%), and colon (9%). All esophageal batteries (n=6) were managed per protocol with immediate endoscopic retrieval. Twentyeight patients presented with gastric batteries; ten (36%) were not managed per protocol. All ten patients were asymptomatic on presentation; however, admitted for observation and serial x-rays. Of these ten patients, six had imaging within twelve hours of presentation that demonstrated transpyloric migration of batteries, and four underwent EGD, with 50% retrieval rate and migration of the battery by the time of intervention. All small bowel batteries (n=6) and three of four asymptomatic colon batteries were managed per protocol; one patient had imaging within 12 hours that demonstrated passage of the battery. In total, eleven of forty-four patients (25%) were not managed per protocol; however, if adherent to our protocol would not require admission, short interval imaging, or intervention and provide a median cost reduction of $1,553 [$152, $3,938] (p=0.04) with identical outcomes.

Conclusions: Adherence to a symptom-based protocol for conservative management of battery ingestions beyond the gastroesophageal junction is safe with minimal complications or need for admission, serial imaging, or intervention, and may provide potential cost benefit.