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Foreign body ingestion in children: Definition of a nomogram to predict surgical or endoscopic intervention
Cecilia Mantegazza1, Simona Ferraro2, Davide Biganzoli3
1Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy.
Insights
This study created a nomogram to predict if children with foreign body ingestion need urgent surgery or endoscopy. This tool helps doctors identify high-risk cases early, preventing complications.
Area of Science:
- Pediatric Gastroenterology
- Medical Diagnostics
- Clinical Prediction Modeling
Background:
- Foreign body ingestion (FBI) in children is a common emergency.
- Timely identification and intervention are crucial to prevent adverse outcomes.
- Current diagnostic methods may not always predict the need for urgent procedures.
Purpose of the Study:
- To develop and validate a predictive nomogram for surgical or endoscopic intervention in pediatric FBI.
- To utilize patient history and clinical data for risk stratification.
- To provide clinicians with a tool for early identification of children requiring urgent intervention.
Main Methods:
- Retrospective multicenter case series analysis of 5864 children admitted for FBI (2015-2020).
- Logistic regression models were employed to determine predictors of intervention.
- A nomogram was developed based on multivariable analysis of clinical parameters.
Main Results:
- Significant predictors for intervention included foreign body type (e.g., disk battery, magnets), pre-existing conditions, drooling, dysphagia, vomiting, retrosternal pain, and hematemesis.
- The developed nomogram demonstrated good predictive ability with an AUC of 0.77.
- Factors like drooling (OR 10.91) and retrosternal pain (OR 5.59) were strongly associated with the need for intervention.
Conclusions:
- The study presents the first nomogram for predicting intervention needs in pediatric foreign body ingestion.
- This tool aids clinicians in identifying children requiring prompt surgical or endoscopic procedures.
- Early identification facilitated by the nomogram can help prevent serious complications in pediatric FBI cases.
Background And Aims:
Foreign body ingestion (FBI) in children requires early identification to prevent adverse outcomes and may necessitate endoscopic or surgical intervention. This study aims to develop a nomogram that identifies children who require urgent surgical or endoscopic intervention by using the patient's medical history and clinical parameters collected at admission.
Methods:
This study is a retrospective review (01/2015-12/2020) of a multicenter case series of children admitted for FBI. Data from 5864 records from 24 hospitals in Italy were analyzed. Logistic regression models were used to establish the probability of requiring surgical or endoscopic intervention based on patient history and clinical characteristics. The nomogram representing the results from the multivariable model was reported to examine the propensity for surgery/endoscopy.
Results:
The study identified a significant association between intervention and various factors, including type of foreign body (blunt: reference category, disk battery (odds ratio OR:4.89), food bolus (OR:1.88), magnets (OR:2.61), sharp-pointed (OR:1.65), unknown (OR:1.02)), pre-existing diseases or conditions (OR 3.42), drooling (OR 10.91), dysphagia (OR 5.58), vomiting (OR 3.30), retrosternal pain (OR 5.59), abdominal pain (OR 1.58), hematemesis (OR 2.82), food refusal/poor feeding (OR 2.99), and unexplained crying (OR 2.01). The multivariable regression model showed good calibration and discrimination ability, with an area under the ROC curve of 0.77.
Conclusions:
This study developed the first nomogram to predict the probability of the need for surgical or endoscopic intervention in children with FBI, based on the information collected at admission. The nomogram will aid clinicians in identifying children who require early intervention to prevent adverse outcomes.
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