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Management of esophageal button battery ingestions: resource utilization and outcomes

Nir Atlas1, Elizabeth M Sinclair2, Harold K Simon3

  • 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA.

Pediatric Surgery International
|January 28, 2022
PubMed

Insights

The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for pediatric esophageal button battery ingestion (EBBI) increased hospital resource use without improving patient outcomes. Further studies are needed to assess costs and resource utilization post-guideline implementation.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Pediatric Surgery

Background:

  • Institutions are increasingly adopting the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for managing pediatric esophageal button battery ingestion (EBBI).
  • Evaluating the impact of these guidelines on clinical practice is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

  • To assess the effect of NASPGHAN guidelines on in-hospital resource utilization.
  • To evaluate short-term clinical outcomes in hemodynamically stable pediatric patients following endoscopic button battery removal.
  • To compare resource use and outcomes between pre- and post-guideline implementation periods.

Main Methods:

  • A single-center retrospective review of all EBBI admissions between 2010 and 2020.
  • Patients were categorized into two groups: pre-guideline (2010-2015) and post-guideline (2016-2020).
  • Analysis focused on in-hospital resource utilization (e.g., imaging, antibiotics, ICU admission, length of stay) and clinical outcomes.

Main Results:

  • The post-guideline group showed a significant increase in magnetic resonance imaging (MRI) use (8.7% vs. 71.4%, p < 0.001).
  • Median antibiotic duration (0 vs. 6 days, p=0.01), pediatric intensive care unit (PICU) admission (0 vs. 3 days, p < 0.001), and total hospital length of stay (5 vs. 11.5 days, p=0.02) were significantly higher post-guideline.
  • Despite normal imaging, two patients in the post-guideline group experienced delayed presentations (tracheoesophageal fistula and aorto-esophageal fistula), though all patients survived to discharge.

Conclusions:

  • Implementation of NASPGHAN guidelines for EBBI management has led to increased resource utilization.
  • The study found no improvement in short-term clinical outcomes despite increased resource use.
  • Further research is warranted to evaluate the cost-effectiveness and resource implications of post-guideline management strategies.
Abstract

Keywords:
Button battery ingestionEsophagusGuidelineLength of stayPediatric intensive careResource utilization

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