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Risk Trajectories of Gastrointestinal Foreign Bodies in Children: A Mixed-Methods Study Integrating Dynamic Imaging
Zhihai Li1, Ruilun Liu2, Zhongyu Wei3
1Department of Ultrasound, Dalang Hospital of Dongguan, Dongguan, Guangdong Province, 523770, People's Republic of China.
Insights
Pediatric gastrointestinal foreign bodies have dynamic risk trajectories. Multidisciplinary team (MDT) involvement improves outcomes for high-risk cases, suggesting a shift from static to dynamic management strategies.
Area of Science:
- Pediatric Gastroenterology
- Clinical Risk Assessment
- Health Services Research
Background:
- Gastrointestinal foreign bodies in children present evolving risks.
- Conventional classification may miss progressive complications.
- Dynamic risk assessment is needed for pediatric foreign bodies.
Purpose of the Study:
- To characterize risk trajectories of pediatric gastrointestinal foreign bodies.
- To evaluate the impact of multidisciplinary team (MDT) involvement on adverse outcomes.
Main Methods:
- Explanatory sequential mixed-methods design with 198 pediatric cases.
- Latent class growth modeling for risk trajectory identification.
- Multivariable regression and critical incident technique for qualitative analysis.
Main Results:
- Four risk trajectories identified: stable low-risk (52%), slow progression (28%), sudden high-risk (12%), and occult perforation (8%).
- MDT involvement significantly improved outcomes for sudden high-risk (OR=3.87) and occult perforation (OR=5.67) trajectories.
- Qualitative analysis highlighted MDT's role in decision-making and outcome improvement.
Conclusions:
- Dynamic, trajectory-based monitoring is superior to static classification for pediatric gastrointestinal foreign bodies.
- MDT involvement is crucial for timely interventions at critical decision points.
- A risk monitoring framework with dynamic imaging can enhance clinical management.
Objective:
The risk associated with gastrointestinal foreign bodies in pediatric populations has evolved dynamically over time. Conventional classification may not adequately identify cases that initially present as low-risk but subsequently progress to clinically significant complications. This study aimed to characterize risk trajectories of pediatric gastrointestinal foreign bodies and to evaluate the impact of multidisciplinary team (MDT) involvement on modifying adverse clinical trajectories.
Methods:
This study employed an explanatory sequential mixed-methods design. A total of 198 pediatric cases with confirmed gastrointestinal foreign bodies were included. Distinct risk trajectories were identified using latent class growth modeling, and multivariable regression analysis was conducted to assess the effect of MDT involvement across trajectory groups. For the qualitative component, purposive sampling identified six representative cases, and the critical incident technique was employed to analyze key decision-making inflection points.
Results:
Four distinct risk trajectories were identified: stable low-risk (52%;, e.g. coins, smooth objects); slow progression (28%; e.g. early-stage button battery ingestion, single magnet ingestion); sudden high-risk (12%; e.g. multiple magnet ingestion, sharp foreign bodies); and occult perforation (8%; e.g. toothpicks, fish bones, hairballs). MDT involvement was significantly associated with improved clinical outcomes for sudden high-risk trajectory (odds ratio [OR] = 3.87) and the occult perforation trajectory (OR = 5.67) trajectories. Qualitative analysis revealed a recurrent decision-making pathway involving incidental imaging findings, multidisciplinary interpretive conflicts, MDT consultation, subsequent modification of clinical management, and improved outcomes.
Conclusion:
The management of gastrointestinal foreign bodies in pediatric populations may benefit from moving beyond static classification to dynamic trajectory-based monitoring. MDT involvement is particularly valuable in facilitating timely interventions at critical decision points. A risk monitoring framework incorporating dynamic imaging may support improved clinical management.
