Research Article| Volume 58, ISSUE 4, P613-618, April 2023

Pediatric button battery ingestion: A single center experience and risk score to predict severe outcomes

Published:December 22, 2022DOI:



      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.


      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.


      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.


      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.



      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)
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        • Mubarak A.
        • Benninga M.A.
        • Broekaert I.
        • Dolinsek J.
        • Homan M.
        • Mas E.
        • et al.
        Diagnosis, management, and prevention of button battery ingestion in childhood: a European society for paediatric gastroenterology Hepatology and nutrition position paper.
        J Pediatr Gastroenterol Nutr. 2021; 73: 129-136
        • Kramer R.E.
        • Lerner D.G.
        • Lin T.
        • Manfredi M.
        • Shah M.
        • Stephen T.
        • et al.
        Management of ingested foreign bodies in children: a clinical report of the NASPGHAN endoscopy committee.
        J Pediatr Gastroenterol Nutr. 2015; 60: 562-574
        • Litovitz T.
        • Whitaker N.
        • Clark L.
        • White N.C.
        • Marsolek M.
        Emerging battery-ingestion hazard: clinical implications.
        Pediatrics. 2010; 125: 1168-1177
        • Leinwand K.
        • Brumbaugh D.E.
        • Kramer R.E.
        Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions.
        Gastrointest Endosc Clin N Am. 2016; 26: 99-118
        • Eliason M.J.
        • Melzer J.M.
        • Winters J.R.
        • Gallagher T.Q.
        Identifying predictive factors for long-term complications following button battery impactions: a case series and literature review.
        Int J Pediatr Otorhinolaryngol. 2016; 87: 198-202
        • Samad L.
        • Ali M.
        • Ramzi H.
        Button battery ingestion: hazards of esophageal impaction.
        J Pediatr Surg. 1999; 34: 1527-1531
        • National Capital Poison Center
        National Capital Poison Center button battery ingestion triage and treatment guideline.
        Date: 2018
        Date accessed: June 1, 2022
        • Philteos J.
        • James A.L.
        • Propst E.J.
        • Ostrow O.
        • McKinnon N.
        • Everett T.
        • et al.
        Airway complications resulting from pediatric esophageal button battery impaction: a systematic review.
        JAMA Otolaryngol Head Neck Surg. 2022; 148: 677-683
        • Gibbs H.
        • Jatana K.R.
        Pediatric button battery injuries—current state and what's next?.
        JAMA Otolaryngol Head Neck Surg. 2022; 148: 683-685
        • Tanaka J.
        • Yamashita M.
        • Kajigaya H.
        Esophageal electrochemical burns due to button type lithium batteries in dogs.
        Vet Hum Toxicol. 1998; 40: 193-196
        • Jatana K.R.
        • Litovitz T.
        • Reilly J.S.
        • Koltai P.J.
        • Rider G.
        • Jacobs I.N.
        Pediatric button battery injuries: 2013 task force update.
        Int J Pediatr Otorhinolaryngol. 2013; 77: 1392-1399
        • Anfang R.R.
        • Jatana K.R.
        • Linn R.L.
        • Rhoades K.
        • Fry J.
        • Jacobs I.N.
        pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury.
        Laryngoscope. 2019; 129: 49-57
        • Lerner D.G.
        • Brumbaugh D.
        • Lightdale J.R.
        Mitigating risks of swallowed button batteries: new strategies before and after removal.
        J Pediatr Gastroenterol Nutr. 2020; 70: 542-546
        • Rosenfeld E.H.
        • Sola R.
        • Yu Y.
        Battery ingestions in children: variations in care and development of a clinical algorithm.
        J Pediatr Surg. 2018; 53: 1537-1541