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Airway Complications Resulting From Pediatric Esophageal Button Battery Impaction: A Systematic Review
Justine Philteos1, Adrian L James1, Evan J Propst1
1Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Button battery ingestion in children can cause severe airway injuries like tracheoesophageal fistulae and vocal cord paralysis. Early recognition and removal are crucial to prevent long-term damage from these button battery (BB) injuries.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Gastroenterology
- Medical Device Safety
Background:
- Button batteries (BBs) in household items pose a significant risk of severe injury to children if ingested.
- Direct contact with the esophagus can lead to liquefactive necrotic effects, causing airway injury.
Purpose of the Study:
- To systematically review airway injuries and their long-term consequences following button battery ingestion in pediatric patients.
- To identify the most common sequelae and risk factors associated with these injuries.
Main Methods:
- A comprehensive systematic review was conducted searching multiple databases (MEDLINE, Embase, Cochrane, Web of Science, CINAHL) up to July 31, 2021.
- Included studies involved pediatric patients (<18 years) with airway injuries post-BB ingestion.
- Data from the National Capital Poison Center BB registry and author-contacted cases were also incorporated.
Main Results:
- 195 pediatric patients were analyzed; 155 cases of tracheoesophageal fistulae and 16 unilateral vocal cord paralyses were observed.
- Twenty-three children experienced bilateral vocal cord paralysis, often after shorter BB exposure times (mean 17.8 hours).
- Children presenting with airway symptoms were more likely to develop tracheoesophageal fistula or vocal cord paralysis.
Conclusions:
- Button battery ingestion is a severe cause of pediatric airway injury, with tracheoesophageal fistulae and vocal cord paralysis being the most frequent outcomes.
- These injuries frequently necessitate tracheostomy, and vocal cord damage can occur with shorter exposure durations.
- Prevention strategies are essential to mitigate the devastating long-term effects of button battery-associated airway injuries.
Importance:
Button batteries (BBs) are commonly found in many household items and present a risk of severe injury to children if ingested. The direct apposition of the trachea and recurrent laryngeal nerves with the esophagus puts children at risk of airway injury secondary to the liquefactive necrotic effects of BB impactions.
Objective:
To review airway injuries, including long-term sequelae, after BB ingestion in children.
Evidence Review:
For this systematic review, a comprehensive strategy was designed to search MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL (Cumulative Index of Nursing and Allied Health Literature) from inception to July 31, 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Additional cases were identified from the National Capital Poison Center BB registry. Individual authors were contacted for additional information. Studies with pediatric patients (<18 years) who developed airway injuries after BB ingestion were included. A total of 195 patients were included in the analysis; 95 were male. The mean (SD) age at BB ingestion was 17.8 (10.2) months. The mean (SD) time from BB ingestion to removal was 5.8 (9.0) days. The 2 most common airway sequelae observed in our series were 155 tracheoesophageal fistulae and 16 unilateral vocal cord paralyses. Twenty-three children had bilateral vocal cord paralysis. The mean (SD) duration of ingestion leading to vocal cord paralysis was shorter than that of the general cohort (17.8 [22.5] hours vs 138.7 [216.7] hours, respectively). Children presenting with airway symptoms were likely to have a subsequent tracheoesophageal fistula or vocal cord paralysis.
Conclusions And Relevance:
Airway injuries are a severe consequence of BB ingestion, occurring more often in younger children. This systematic review found that tracheoesophageal fistulae and vocal cord paralyses were the 2 most common airway injuries, often requiring tracheostomy. Vocal cord injury occurred after a shorter BB exposure time than other airway injuries. Continued efforts should be directed toward prevention strategies to avoid the devastating sequelae of BB-associated airway injury.
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