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Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes
P Nina Scalise1, Jonathan M Durgin1, Steven J Staffa2
1Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States.
Insights
Button battery ingestions in children can lead to severe outcomes. A risk score identifying esophageal location, large battery size, and symptoms can predict these severe outcomes, aiding in resource allocation.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Otolaryngology
Background:
- Button battery ingestions are a common pediatric emergency.
- Ingestion can lead to severe esophageal injury and long-term sequelae.
- Effective management requires accurate risk stratification.
Purpose of the Study:
- To analyze the management and outcomes of pediatric button battery ingestions.
- To identify predictors of severe outcomes.
- To develop a risk score for predicting severe outcomes.
Main Methods:
- Retrospective review of 143 pediatric patients (2008-2021) with button battery ingestion.
- Definition of severe outcome: deep mucosal erosion, perforation, mediastinitis, vascular/airway injury, or stricture.
- Logistic regression to identify predictors and develop a risk score.
Main Results:
- 17% of patients experienced a severe outcome.
- Independent predictors of severe outcome: esophageal location (96%), battery size ≥2 cm (95%), and symptoms (96%).
- Predicted severe outcome probability ranged from 0.3% to 88% based on risk factors.
Conclusions:
- A risk score incorporating esophageal location, battery size, and symptoms can predict severe outcomes in pediatric button battery ingestions.
- This score can guide resource allocation and expedite transfer to specialized centers.
- Early identification of high-risk patients is crucial for optimal management and prevention of complications.
Purpose:
The purpose of this study was to analyze the management and outcomes of primary button battery ingestions and their sequelae at a single high-volume center, and to propose a risk score to predict the likelihood of a severe outcome.
Methods:
The medical record was queried for all patients under 21 years old evaluated at our institution for button battery ingestion from 2008 to 2021. A severe outcome was defined as having at least one of the following: deep/circumferential mucosal erosion, perforation, mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture. From a selection of clinically relevant factors, logistic regression determined predictors of a severe outcome, which were incorporated into a risk model.
Results:
143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a severe outcome. The independent predictors of a severe outcome in multivariate analysis were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm (95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases. Predicted probability of a severe outcome ranged from 88% when all three risk factors were observed, to 0.3% when none were present.
Conclusion:
We report the presentation, management, and complication profiles of a large cohort of BB ingestions treated at a single institution. A risk score to predict severe outcomes may be used by providers initially evaluating patients with button battery ingestion in order to allocate resources and expedite transfer to a center with pediatric endoscopic and surgical capabilities.
Level Of Evidence:
Level IV.
Type Of Study:
Clinical Research Paper.
