Abstract
Purpose
The purpose of this study was to analyze the management and outcomes of primary button
battery ingestions and their sequelae at a single high-volume center, and to propose
a risk score to predict the likelihood of a severe outcome.
Methods
The medical record was queried for all patients under 21 years old evaluated at our
institution for button battery ingestion from 2008 to 2021. A severe outcome was defined
as having at least one of the following: deep/circumferential mucosal erosion, perforation,
mediastinitis, vascular or airway injury/fistula, or development of esophageal stricture.
From a selection of clinically relevant factors, logistic regression determined predictors
of a severe outcome, which were incorporated into a risk model.
Results
143 patients evaluated for button battery ingestion were analyzed. 24 (17%) had a
severe outcome. The independent predictors of a severe outcome in multivariate analysis
were location of battery in the esophagus on imaging (96%), battery size >/ = 2 cm
(95%), and presence of any symptoms on presentation (96%), with P < 0.001 in all cases.
Predicted probability of a severe outcome ranged from 88% when all three risk factors
were observed, to 0.3% when none were present.
Conclusion
We report the presentation, management, and complication profiles of a large cohort
of BB ingestions treated at a single institution. A risk score to predict severe outcomes
may be used by providers initially evaluating patients with button battery ingestion
in order to allocate resources and expedite transfer to a center with pediatric endoscopic
and surgical capabilities.
Level of evidence
Level IV.
Type of study
Clinical Research Paper.
Keywords
Abbreviations:
AUC (Area under the curve), BB (Button battery), BBTF (Button Battery Task Force), CT (Computed tomography), ESPGHAN (European Society for Pediatric Gastroenterology Hepatology and Nutrition), EGD (Esophagogastroduodenoscopy), GEJ (Gastroesophageal junction), IRB (Institutional Review Board), ICD (International Classification of Disease), LOS (Length of stay), NBIH (National Battery Ingestion Hotline), NCPC (National Capital Poison Center), NSO (Non-severe outcome), NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition), NPO (Nothing by mouth), SO (Severe outcome), TEF (Tracheoesophageal fistula)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 22, 2022
Accepted:
December 12,
2022
Received:
December 8,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
