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Foreign body ingestion in children: Impact of a digital app on clinical decision-making
Francesca Gigola1, Ambrogio Silecchia2, Niccolò Parri3
1School of Paediatric Surgery, University of Florence, Florence, Italy; Department of Paediatric Surgical Specialties, Meyer Children's Hospital IRCCS, Florence, Italy.
Insights
Foreign body ingestion (FBI) in children is common, but management is inconsistent. Structured decision support tools can improve adherence to guidelines and reduce unnecessary interventions and transfers.
Area of Science:
- Pediatric Emergency Medicine
- Gastroenterology
- Clinical Protocol Development
Background:
- Foreign body ingestion (FBI) is a frequent cause of pediatric emergency department visits.
- While many cases resolve spontaneously, some require urgent intervention, highlighting the need for standardized care.
- Adherence to evidence-based protocols is crucial for preventing complications in pediatric FBI cases.
Purpose of the Study:
- To evaluate the adherence to established guidelines in the management of pediatric foreign body ingestion.
- To identify deviations from best practices and assess the impact of interhospital transfers on patient outcomes.
- To explore the potential of digital decision-support tools in standardizing pediatric FBI management.
Main Methods:
- Retrospective analysis of 475 pediatric FBI cases over four years at a single center.
- Comparison of clinical data with international guidelines and recommendations from a digital decision-support tool.
- Statistical analysis to identify factors influencing management deviations and hospitalisation rates.
Main Results:
- The majority of pediatric FBI cases involved blunt objects in children aged 2-5 years; most were asymptomatic.
- Interhospital transfers were associated with increased hospitalisation rates, with 37% deemed potentially avoidable.
- 3.2% of cases deviated from guideline-based management, often involving unnecessary procedures or omitted imaging, particularly in transferred patients.
Conclusions:
- Pediatric foreign body ingestion management is heterogeneous, with significant deviations from recommended protocols.
- Avoidable transfers and procedures are common, indicating a need for improved adherence to guidelines.
- Structured decision-support algorithms show promise in reducing avoidable transfers and enhancing guideline adherence within pediatric networks.
Background:
Foreign Body Ingestion (FBI) is a common reason for paediatric Emergency Department (ED) visits. Although most cases resolve spontaneously, a significant proportion requires urgent intervention. Adherence to standardised, evidence-based protocols is essential to prevent complications and ensure appropriate care.
Methods:
This retrospective, single-centre study analysed all paediatric FBI cases over a four-year period. Demographic, clinical, and management data were retrieved and compared with international guidelines and recommendations from the Corpi Estranei mobile application, a digital decision-support tool derived from North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN) protocols.
Results:
A total of 475 confirmed cases were identified (59.6% males). Most patients were aged 2-5 years (50.3%), and blunt objects were the most frequently ingested items (82.5%). Most children were asymptomatic (72.6%), while 26% required hospitalisation. Among admitted patients, 64.7% underwent endoscopic or surgical intervention. Interhospital transfers significantly increased hospitalisation rates; however, 37% of transfers were potentially avoidable. Fifteen cases (3.2%) deviated from guideline-based management, mainly due to unnecessary or delayed procedures or omitted imaging, most of which involved transferred patients (p < 0.05).
Conclusions:
Management of paediatric FBI remains heterogeneous, with frequent deviations from recommended protocols and a notable rate of avoidable transfers and procedures. This study suggests that structured decision-support algorithms may help reduce avoidable transfers and improve guideline adherence in regional paediatric networks.
