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Vascular Complications in Children Following Button Battery Ingestions: A Systematic Review
Olugbenga Akinkugbe1, Adrian L James2, Olivia Ostrow3
1Departments of Critical Care Medicine.
Insights
Button battery (BB) impaction in children can lead to fatal vascular complications, especially with prolonged impaction. Prompt medical attention for hematemesis after BB ingestion is crucial for survival.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Emergency Medicine
Background:
- Button battery (BB) ingestion is a significant cause of pediatric emergencies.
- Vascular complications, including aorto-esophageal fistulae, are severe outcomes of BB impaction.
- Early recognition and intervention are critical for improving patient outcomes.
Purpose of the Study:
- To characterize children experiencing vascular complications following button battery (BB) impaction.
- To analyze the outcomes associated with these severe BB-related injuries in pediatric patients.
- To identify risk factors and inform clinical management strategies.
Main Methods:
- A comprehensive review of the National Capital Poison Center registry and PubMed database up to December 2021.
- Inclusion of all reported cases of children (<18 years) with vascular, esophageal, or airway complications post-BB ingestion.
- Extraction of data on demographics, battery specifics, impaction details, complications, interventions, and survival intervals.
Main Results:
- Out of 361 severe cases, 19% were fatal and 14% involved vascular injuries.
- Aorto-esophageal fistulae comprised 75% of vascular complications, with 82% being non-survivable.
- Fatal cases showed significantly longer impaction times (median 144 hours vs. 96 hours).
Conclusions:
- Prolonged button battery (BB) impaction is a critical risk factor for life-threatening vascular complications and mortality.
- Hematemesis in children with suspected BB impaction warrants high suspicion and immediate transfer to a tertiary care center.
- Timely vascular surgical intervention may be life-saving for patients with severe BB-induced injuries.
Context:
Children presenting to health care facilities with button battery (BB) impaction.
Objectives:
To describe characteristics of children with vascular complications after BB impaction, as well as associated outcomes.
Data Sources:
National Capital Poison Center registry and PubMed database from inception to December 2021.
Study Selection:
All reports describing children aged <18 years with vascular, esophageal, or airway complications after BB ingestion.
Data Extraction:
We extracted characteristics including date of publication, age and sex of child, battery type and size, duration and location of impaction, complications, subsequent interventions, and interval between battery removal and death.
Results:
A total of 361 cases involved severe complications or death after BB ingestion (321 cases from the National Capital Poison Center registry database, 40 additional cases from PubMed). Nineteen percent (69 of 361) were fatal and 14% (51 of 361) involved vascular injuries. Three-quarters (75%) of vascular complications were aorto-esophageal fistulae and 82% of vascular injuries were not survivable. Fatal vascular cases had significantly longer median impaction time (96 hours versus 144 hours, P <.05) and a wider range of presenting features than survivors.
Limitations:
The total number of cases with vascular complications was small, data reported varied between cases, and no data were available on overall exposure. Long-term morbidity data were not available for the survivors.
Conclusions:
Prolonged BB impaction is a risk factor for vascular complications and death. A high index of suspicion is required for children representing with hematemesis after BB impaction, with prompt transfer to a tertiary center because vascular surgical intervention may offer a chance of survival.
