Button battery exposure in children: a systematic review and meta-analysis

There is a rising burden of severe and fatal outcomes resulting from button battery exposures (ingestions or insertions). We summarised current evidence following button battery exposures in children and provided pooled prevalence estimates for key clinical characteristics, complications and risk estimates for predictors.

MEDLINE, Embase and Scopus databases were searched up to 19 May 2023. Included studies described complications of button battery exposures in children aged <18 years and reported prevalence data, an OR estimate or allowed OR calculation. Random effects models were used to estimate pooled estimates and event rates.

Forty-four articles (3125 children) were included in the analysis. Battery exposures were more common in males (59%) and young children. For ingestions, batteries were most often located in the stomach (43%). Mucosal damage (46%) and oesophageal stricture (10%) were the most common complications. Most (60%) children were asymptomatic at presentation. When symptoms were present, vomiting (26%) and dysphagia (18%) were the most common. Duration of ingestion to removal increased the likelihood of any complication; OR 3.71 (95% CI 1.11 to 12.42) for ≥10 hours and 5.12 (95% CI 1.79 to 14.67) for ≥12 hours. Battery diameter ≥20 mm was associated with any complication OR 4.34 (95% CI 1.16 to 16.27) and oesophageal location OR 18.66 (95% CI 6.99 to 49.82). Death was associated with oesophageal impaction OR 15.52 (95% CI 2.40 to 100.27). For insertions, nasal septal perforation was the most common complication (13%).

Button batteries are a potentially fatal domestic hazard particularly for young children. Increased prevention efforts through safer battery design are needed to mitigate this risk.