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Published on: September 11, 2018
Defining radiological progression in children who have ingested multiple magnets using a novel objective tool applied
Jonathan J Neville1, Costa Healy2, Bashar Aldeiri3
1University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton UK.
Background:
The decision to operate on asymptomatic children who have ingested multiple magnetic objects is based on a subjective assessment of magnet progression via serial abdominal radiographs at non-standardised time-points. We aimed to develop an objective tool to identify non-progression on serial abdominal radiographs.
Method:
Children (aged ≤16 years) who ingested two or more magnetic objects in one episode were identified from four UK paediatric surgery centres. Asymptomatic children who had undergone two or more abdominal radiographs, without radiological evidence of obstruction or pneumoperitoneum, were included. Each abdominal radiograph was divided into a 3x3 grid and progression was defined as movement of magnets from one grid region to another between two serial radiographs. Magnet-related injuries were recorded.
Results:
Thirty-one children, ingesting a median of 3 magnets (range: 2-20), were included. Of these 10/31 (32 %) underwent a surgical intervention with 5/31 (16 %) confirmed to have a magnet-related injury. Timing of radiographs varied with 21/31 (68 %) undergoing at least one follow-up radiograph within 24 h and 29/31 (94 %) in the first 48 h. Children with a magnet-related injury had non-progression identified earlier. No child with two consecutive episodes of progression developed a magnet-related injury, whereas two consecutive episodes of non-progression were strongly associated with magnet-related injury.
Conclusion:
A 3x3 grid system overlaying the abdominal radiograph provides an objective tool to evaluate magnet progression. We suggest an imaging protocol consisting of at least three abdominal radiographs within the first 36-48 h, with risk-based adjustment of imaging frequency thereafter. Combined with standardisation of radiograph timing, the grid system may facilitate earlier intervention in those with non-progression, safe early discharge in those without injury, and overall reduced radiation exposure.
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