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Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children
Published on: September 11, 2018
Risk Factors Associated with Endoscopic Intervention in Pediatric Patients Presenting with Foreign Body Ingestion to
Young-Hoon Byun1, Ji Eun Kim2, So Hyun Paek1
1Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea.
Insights
Pediatric foreign body ingestion often requires endoscopy. While established criteria guide decisions, this study found coin ingestion may also be a high-risk factor, suggesting it warrants consideration for esophagogastroduodenoscopy.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Clinical Outcomes Research
Background:
- Pediatric foreign body (FB) ingestion is a frequent emergency department presentation.
- Established high-risk criteria guide the need for esophagogastroduodenoscopy (EGDS), but coins are not uniformly classified as high-risk.
- Understanding predictors of EGDS is crucial for timely intervention in pediatric FB ingestions.
Purpose of the Study:
- To delineate the epidemiology and endoscopic outcomes of pediatric foreign body ingestion.
- To identify predictors influencing the decision for esophagogastroduodenoscopy (EGDS) in children.
- To evaluate the role of coin ingestion as a potential high-risk factor for EGDS.
Main Methods:
- Retrospective review of 757 children (<15 years) with suspected or confirmed FB ingestion from 2014-2020.
- Data included demographics, symptoms, FB type/location, ED length of stay, and EGDS outcomes.
- Multivariable logistic regression analyzed predictors of EGDS, including established high-risk criteria and FB type (coin, button battery, magnet).
Main Results:
- Esophagogastroduodenoscopy (EGDS) was performed in 6.2% of cases, with a 74.5% success rate.
- Established high-risk criteria were the strongest predictor of EGDS (aOR ≈ 179.4).
- Coin ingestion showed an independent association with EGDS compared to button batteries (aOR ≈ 7.26, p=0.042).
Conclusions:
- Established high-risk criteria remain the primary driver for performing EGDS in pediatric FB ingestions.
- Coin ingestion demonstrated an independent association with EGDS, suggesting it may be a high-risk factor.
- Consideration of coin ingestion as a high-risk factor may refine indications for endoscopy in pediatric FB ingestions.
Abstract:
Background/Objectives: Pediatric foreign body (FB) ingestion is a common clinical problem that frequently necessitates time-sensitive decisions regarding esophagogastroduodenoscopy (EGDS). Although established high-risk criteria guide the indication for EGDS, coins-despite their high prevalence-are not uniformly classified as high-risk FBs. In this study, we aimed to delineate epidemiology and endoscopic outcomes and to identify predictors of EGDS. Methods: We retrospectively reviewed cases of children younger than 15 years presenting to an urban emergency department (ED) with suspected or confirmed FB ingestion between 2014 and 2020. After applying exclusion criteria, 757 patients remained for analysis. Data abstracted included demographic characteristics, presenting symptoms, type and location of FB, ED length of stay (EDLOS), and whether EGDS was performed along with its outcomes. Multivariable logistic regression was used to identify predictors of EGDS, including age group, sex, symptom presence, established high-risk criteria, and type of FB (coin, button battery, magnet). Results: Among 757 children (median age 17.0 months; 54.0% male), 55.2% were asymptomatic. EGDS was performed in 47 of the 757 children (6.2%), with a success rate of 74.5% (35/47). Among EGDS cases, the most common foreign bodies were coins (29.8%), button batteries (27.7%), and magnets (17.0%). In multivariable models, established high-risk criteria were the dominant determinant of EGDS (adjusted OR ≈ 179.4; 95% CI, 29.9-1075.8; p < 0.001). Compared with button batteries, coin ingestion was independently associated with EGDS (adjusted OR ≈ 7.26; 95% CI, 1.07-49.31; p = 0.042). Conclusions: Established high-risk criteria were the primary determinant of EGDS, and coin ingestion showed a possible independent association with EGDS; these findings suggest that coin ingestion may warrant consideration as a potential high-risk factor when determining whether endoscopy is indicated.
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