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Yalcin G, Derinoz-Guleryuz O, Alan DH, Akca-Caglar A. How should one intervene when a foreign body is blocking a child's oral cavity? Paediatr Int Child Health 2024; 44:30-33. [PMID: 38334132 DOI: 10.1080/20469047.2024.2313298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Foreign bodies lodged in the oral cavity can be life-threatening. Their removal should be determined on the basis of the patient's condition, the type of object, the removal techniques available, the appropriate medication available and the potential complications. CASE REPORT A 9-month-old girl was brought to the emergency room by ambulance after a part of a toy became stuck in her oral cavity. Her father had unsuccessfully attempted to remove it at home. A blue cylindrical, rigid plastic toy part was seen during examination of her oral cavity and her tongue was trapped inside it. On initial assessment, her vital signs were within the normal range. She was agitated, a small amount of saliva mixed with blood was coming out of her mouth and she could not swallow her spittle. She was treated in the resuscitation room by an otorhinolaryngologist and a paediatric emergency team, and the foreign body was removed using bayonet forceps inside the mouth. The child was monitored in the paediatric emergency observation unit for 6 hours for signs of asphyxia and aspiration, and she was discharged without complications. CONCLUSION Foreign bodies in the oral cavity can cause serious complications, including injury, bleeding and sudden airway obstruction. Experienced healthcare professionals, especially those skilled in airway management, should handle these cases using a multidisciplinary approach to ensure respiratory safety.Abbreviations: LMA: laryngeal mask airway; PED: paediatric emergency department.
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Affiliation(s)
- Gamze Yalcin
- Department of Paediatrics, Faculty of Medıcıne, Gazı Unıversıty, Ankara, Turkıye
| | - Oksan Derinoz-Guleryuz
- Division of Paediatric Emergency, Department of Paediatrics, Faculty of Medıcıne, Gazı Unıversıty, Ankara, Turkıye
| | - Deniz Han Alan
- Department of Otorhinolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayla Akca-Caglar
- Division of Paediatric Emergency, Department of Paediatrics, Faculty of Medıcıne, Gazı Unıversıty, Ankara, Turkıye
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2
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Saw-Aung M, Kong RM, Cipriano N, Daniels A, Newen NL, Goldstein NA, Plum AW. National Trends of Pediatric Aspirated/Ingested Foreign Bodies. Clin Pediatr (Phila) 2024; 63:531-540. [PMID: 37377192 DOI: 10.1177/00099228231181978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Foreign body (FB) aspiration/ingestion in children represents a major cause of hospital admission and mortality. Evaluating risk factors and identifying trends in specific FB products could improve targeted health literacy and policy changes. A cross-sectional study querying emergency department patients less than 18 years old with a diagnosis of aspirated/ingested FB was conducted using the National Electronic Injury Surveillance System database between 2010 and 2020. Incidence rates per 100 000 people-year were calculated and multivariate analyses were performed to identify risk factors for hospital admission and mortality. There has been a significantly decreasing rate of aspirated (-23.6%; P = .013) but not ingested FB (-9.4%; P = .066) within the study period. Within pediatric aspirated FB, black compared with white patients had decreased odds of same hospital admission (odds ratio [OR]: 0.8), but increased odds of transfer admission (OR: 1.6) and mortality (OR: 9.2) (all, P < .001).
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Affiliation(s)
- Monica Saw-Aung
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Ryan M Kong
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Natalie Cipriano
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Adam Daniels
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Naomi L Newen
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Nira A Goldstein
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Ann W Plum
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
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Lehembre-Shiah E, Gomez-Lobo V. Vaginal Foreign Bodies in the Pediatric and Adolescent Age Group: A Review of Current Literature and Discussion of Best Practices in Diagnosis and Management. J Pediatr Adolesc Gynecol 2024; 37:121-125. [PMID: 38012979 PMCID: PMC10994743 DOI: 10.1016/j.jpag.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
The self-insertion of a vaginal foreign body (VFB) is common in the female pediatric and adolescent age group. Prompt disclosure to parents usually results in a call to the primary care provider and a visit to the pediatrician's office, local emergency department, or urgent care center. However, some foreign bodies may go unnoticed for extended periods, causing distressing symptoms and complications. Large case series providing comprehensive epidemiological data on this topic are scarce. This review summarizes the current literature on VFBs and compiles best practices for the diagnosis and management of VFBs in the pediatric and adolescent population.
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Affiliation(s)
| | - Veronica Gomez-Lobo
- National Institute of Child Health and Human Development, Bethesda, Maryland
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Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model. Ann Emerg Med 2024; 83:351-359. [PMID: 37725021 DOI: 10.1016/j.annemergmed.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
STUDY OBJECTIVE Button battery ingestion can cause alkaline esophageal injury. There is interest in first-aid household products to neutralize the injury. The objective was to investigate which household products are effective at reducing button battery injury. METHODS Two cadaveric porcine experiments were performed. Experiment 1 utilized esophageal mucosal segments. A button battery (3VCR2032) was placed onto the mucosa, and substances (saline control, honey, jam, orange juice, yogurt, milk, and cola) were applied every 10 minutes for 6 applications. Tissue pH was measured every 10 minutes, and macroscopic ulceration size was assessed at 120 minutes. Experiment 2 used an intact esophageal model with a battery inserted into the lumen and jam, honey, and saline irrigation as per experiment 1. Tissue pH, macroscopic and histopathology changes were evaluated at 60, 90 and 120 minutes. RESULTS In experiment 1, only honey and jam had a lower mean tissue pH at 120 minutes (8.0 [standard deviation [SD] 0.9, n=12] and 7.1 [SD 1.7, n=12], respectively) compared to saline solution 11.9 (SD 0.6, n=6, P<.0001). Both honey (0.24 cm2, SD 0.17) and jam (0.37 cm2, SD 0.40) had smaller mean areas of ulceration compared to saline solution (3.90 cm2, SD 1.03, P<.0001). In experiment 2, honey and jam had significantly lower mean tissue pH at all timepoints compared to saline solution. Histologic changes were evident at 60 minutes in the saline group, whereas honey and jam exhibited no or minimal changes until 120 minutes. CONCLUSIONS Honey and jam were able to neutralize injury caused by a button battery resulting in a smaller area of ulceration. Jam should be further explored as a possible first-aid option as an alternative to honey in suspected button battery ingestion prior to definitive management.
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Affiliation(s)
- Angela L Chiew
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia.
| | - Calvin S Lin
- University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia
| | - Dan T Nguyen
- Department of Anatomical Pathology, Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | - Felicity A W Sinclair
- Department of Anatomical Pathology, Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
| | - Betty S Chan
- Department of Clinical Toxicology, Prince of Wales Hospital, Randwick, NSW, Australia; University of New South Wales, Prince of Wales Clinical School, Faculty of Medicine, Sydney, NSW, Australia
| | - Annalisa Solinas
- Department of Anatomical Pathology, Prince of Wales Hospital, NSW Health Pathology, Randwick, NSW, Australia
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Grandjean-Blanchet C, Eltorki M, Strickland M, Kang A, Wen A, Rosenfield D. Evaluating Multiple Magnet Ingestion at 2 Large Canadian Pediatric Hospitals After Reintroduction to the US Marketplace. Pediatr Emerg Care 2024; 40:214-217. [PMID: 37083691 DOI: 10.1097/pec.0000000000002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES To determine the trend in incidence of pediatric magnet ingestions at 2 large Canadian tertiary pediatric hospitals after reintroduction of magnets to the US marketplace and to evaluate morbidity and mortality related to these ingestions. METHODS This was a retrospective study performed in 2 tertiary care pediatric hospitals between 2004 and 2019. We reviewed the charts of all children who presented with a foreign body ingestion and included those with reported magnet ingestion. We characterized all events and compared the incidence rate before and after the US ban was overturned in 2016. Descriptive statistics were used to summarize our results. Incidence rate ratio was calculated using the total number of magnet ingestion cases and total emergency department visits normalized to 100,000 emergency department visits/year. RESULTS We screened a total of 6586 ingestions and identified 192 patients with magnet ingestions. The period after the mandatory recall was compared with the period after the US ban revocation yielding an incidence rate ratio of 0.76 for all magnet ingestions ( P = 0.15) and 0.73 ( P = 0.34) for multiple magnet ingestions. There was, however, a graphical upward trend that immediately followed the US ban revocation. Sixty-nine patients (36%) were admitted to the hospital and 45 (23%) required a procedure to remove the magnet ingested. No deaths occurred. CONCLUSIONS Our findings suggest that the overturning of the US ban did not lead to a significant increase in the incidence of rare earth magnet ingestion in 2 large tertiary pediatric hospitals in Canada despite noting a trend upwards.
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Affiliation(s)
| | - Mohamed Eltorki
- McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Matt Strickland
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Aaron Wen
- McMaster Children's Hospital, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Hardin JR, Suzuki E, Seltzer JA, Suhandynata RT, Sivagnanam M, Lasoff DR. Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient. Wilderness Environ Med 2024; 35:70-73. [PMID: 38379476 DOI: 10.1177/10806032231222373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335 ug/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.
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Affiliation(s)
- Jeremy R Hardin
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| | - Emi Suzuki
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA
- Rady Children's Hospital, San Diego, CA
| | - Justin A Seltzer
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
| | - Raymond T Suhandynata
- Department of Pathology, UC San Diego Health, San Diego, CA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego Health, San Diego, CA
| | - Mamata Sivagnanam
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California, San Diego, CA
- Rady Children's Hospital, San Diego, CA
| | - Daniel R Lasoff
- Division of Medical Toxicology, Department of Emergency Medicine, UC San Diego Health, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
- San Diego Division, California Poison Control System, San Diego, CA
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Kara K, Ozdemir C, Tural Onur S, Satici C, Tokgoz Akyil F, Nedime Sokucu S. Late Diagnosis of Foreign Body Aspiration in Adults: Case Series and Review of the Literature. Respir Care 2024; 69:317-324. [PMID: 37935526 PMCID: PMC10984597 DOI: 10.4187/respcare.10723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS Of the 255 patients with FBA, 17.6% (N = 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Forty-two percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue.
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Affiliation(s)
- Kaan Kara
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey.
| | - Cengiz Ozdemir
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Seda Tural Onur
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Celal Satici
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Fatma Tokgoz Akyil
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
| | - Sinem Nedime Sokucu
- Drs Kara, Tural Onur, Satici, Tokgoz Akyil, and Nedime Sokucu are affiliated with Chest Disease, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey. Dr Ozdemir is affiliated with Chest Disease, Liv Hospital, Istanbul, Turkey
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Pozailov S, Goldbart A, Aviram M, Maimon MS, Dizitzer Hillel Y, Gatt D, Raviv I, Avraham S, Kaplan O, Tsaregorodtsev S, Golan-Tripto I. Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children. Eur J Pediatr 2024; 183:815-825. [PMID: 38017338 DOI: 10.1007/s00431-023-05347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0-18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1-3; moderate, 4-6; high, 7-10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11-39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P < .001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78-4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016-2019 to 50% in 2020 (P = .042). CONCLUSION FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. WHAT IS KNOWN • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process. WHAT IS NEW • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.
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Affiliation(s)
- Shani Pozailov
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Micha Aviram
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal S Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yotam Dizitzer Hillel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Dvir Gatt
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Raviv
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shir Avraham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Or Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesiology and Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.
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9
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McLeish S, Harwood R, Decker E, Almond S, Hall NJ, Durand C. Managing magnets: An audit of introduction of the Royal College of Emergency Medicine Best Practice Guideline. Acta Paediatr 2024; 113:127-134. [PMID: 37641921 DOI: 10.1111/apa.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
AIM To evaluate management of children and young people presenting to the Emergency Department (ED) with magnet ingestion before and after new guidance. METHODS In May 2021, a National Patient Safety Agency and Royal College of Emergency Medicine (RCEM) Best Practice Guideline about management of ingested magnets was published. This was implemented in our department. Children and young people presenting after magnet ingestion were identified from SNOMED (coded routinely collected data) and X-ray requests between January 2016 and March 2022. Management was compared to national guidance. RESULTS There were 138 patient episodes of magnet ingestion, with a rising incidence over the 5-year period. Following introduction of the guideline, there was a higher incidence of admission (36% vs. 20%) and operative intervention (15.7% vs. 8%). Use of follow-up X-ray increased from 56% to 90%. There was substantial variation in the management prior to guidance which reduced after introduction of the RCEM guidance. CONCLUSION Management of magnet ingestion has become more standardised since introduction of the National RCEM Best Practice Guideline, but there is still room for improvement.
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Affiliation(s)
- S McLeish
- Emergency Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Harwood
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Decker
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Almond
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - N J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C Durand
- Emergency Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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10
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Kilroe MJ, McAtee KJ, McReynolds TM. A Case Report of Food Impaction Relieved by Warm Water Drinking Therapy. J Emerg Med 2024; 66:e27-e28. [PMID: 37867036 DOI: 10.1016/j.jemermed.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Emergency department (ED) management of esophageal food impaction without high-grade obstruction is highly variable, without definitive and validated interventions being supported in medical literature. CASE REPORT We discuss a 34-year-old male patient with diagnosis of eosinophilic esophagitis and history of multiple food impactions presenting to the ED with a food impaction. Based on a known esophageal history with repeated failure of pharmacologic interventions, the patient was submitted to a new conservative treatment of warm water drinking. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report suggests warm water ingestion as a novel, safe, and successful treatment method in the management of esophageal food bolus impaction. As a conservative treatment not deviating greatly from current ED treatment options, it can reduce patient length of stay and decrease exposure to potential morbidity via invasive endoscopic or surgical intervention. It should be further investigated and validated with a large cohort study.
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Affiliation(s)
- Matthew J Kilroe
- Emergency Medicine Residency Program, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Kyle J McAtee
- Emergency Medicine Residency Program, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Tamara M McReynolds
- Emergency Medicine Residency Program, Carl R. Darnall Army Medical Center, Fort Hood, Texas
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11
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Martínez-Isasi S, Carballo-Fazanes A, Jorge-Soto C, Otero-Agra M, Fernández-Méndez F, Barcala-Furelos R, Izquierdo V, García-Martínez M, Rodríguez-Núñez A. School children brief training to save foreign body airway obstruction. Eur J Pediatr 2023; 182:5483-5491. [PMID: 37777603 PMCID: PMC10746610 DOI: 10.1007/s00431-023-05202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/02/2023]
Abstract
Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate action will determine the victim's outcome. Although many school children's basic life support (BLS) training programs have been implemented in recent years, references to specific training on FBAO are lacking. Therefore, the aim was to assess FBAO-solving knowledge acquisition in 10-13-year-old school children. A quasi-experimental non-controlled simulation study was carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia (Spain). Participants received a 60-min training led by their physical education teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on training) on how to help to solve an FBAO event. After the training session, the school children's skills were assessed in a standardized adult's progressive FBAO simulation scenario. The assessment was carried out by proficient researchers utilizing a comprehensive checklist specifically designed to address the variables involved in resolving a FBAO event according with current international guidelines. The assessment of school children's acquired knowledge during the simulated mild FBAO revealed that 62.2% of participants successfully identified the event and promptly encouraged the simulated patient to cough actively. When the obstruction progressed, its severity was recognized by 86.2% and back blows were administered, followed by abdominal thrusts by 90.4%. When the simulated victim became unconscious, 77.1% of children identified the situation and immediately called the emergency medical service and 81.1% initiated chest compressions. No significant differences in performance were detected according to participants' age. Conclusion: A brief focused training contributes to prepare 10-13-year-old school children to perform the recommended FBAO steps in a standardized simulated patient. We consider that FBAO should be included in BLS training programs for school children. What is Known: • Kids Save Lives strategy states that school children should learn basic life support (BLS) skills because of their potential role as first responders. • This BLS training does not include content for resolving a foreign body airway obstruction (FBAO). What is New: • Following a 60-min theoretical-practical training led by physical education teachers, 10-13-year-old school children are able to solve a simulated FBAO situation. • The inclusion of FBAO content in BLS training in schools should be considered.
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Affiliation(s)
- Santiago Martínez-Isasi
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
| | - Aida Carballo-Fazanes
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain.
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain.
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain.
| | - Cristina Jorge-Soto
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
- Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra, Spain
| | - Felipe Fernández-Méndez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
- Escuela de Enfermería de Pontevedra, Universidade de Vigo, Pontevedra, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
| | - Verónica Izquierdo
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
| | | | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation, Life Support, and Intensive Care Research Unit, (SICRUS) of the Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, Av/Xoan XXIII, S/N, 15782, Santiago de Compostela, Spain
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Instituto de Salud Carlos III, RD21/0012/0025, Madrid, Spain
- Pediatric Critical, Intermediate and Palliative Care Section, Pediatric Area, Santiago de Compostela's University Clinic Hospital, Santiago de Compostela, Spain
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Duman D, Aykan HH, Ertuğrul İ, Ardiçli B, Aypar E, Alehan D, Karagöz T. Percutaneous Transcatheter Retrieval of Central Venous Port Fragments in Pediatric Patients; A Single-center Experience From the Pediatric Cardiology Department. J Pediatr Hematol Oncol 2023; 45:e959-e965. [PMID: 37782316 DOI: 10.1097/mph.0000000000002761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Split/fracture and embolization of central venous/shunt catheters are rare but serious complications in children. Percutaneous retrieval of intravascular foreign bodies is an important minimal invasive treatment. This study is aimed to represent our largest pediatric sample experience till now of 17 years from a single institution. Another aim is to compare the results regarding the removal or leaving in place of embolized or ruptured intravascular or cardiac venous catheter parts in children. PATIENTS AND METHODS A total of 26 cases were included in this study. Any pediatric patient with normal coagulation parameters and a fractured catheter fragment was included in this study. Other intravascular foreign bodies related to interventional devices and/or pacemaker/implantable cardiac defibrillator leads were excluded from this study. RESULTS Twenty-six patients, of whom 25 had oncologic diseases and 1 had a ventriculoatrial shunt, were included. The median age was 83.5 months (between 20 mo and 18 y) at treatment.Superior vena cava (9 cases), followed by the right atrium (5 cases), were the most two common sites of embolization for cardiovascular foreign bodies. The success rate of percutaneous retrieval was 92.3% in all patients. There were neither complications nor deaths. The retrieval technique revealed a predisposition for extraction through the femoral vein (96.1%) and using snare techniques (100%). Additional catheters like pigtail, National Institutes of Health, or ablation catheters were used for stabilization in selective cases in which the permanent central venous fragments stuck to the vessels. A tractional maneuver and capturing the ruptured material in the middle were other trick points for successful retrieval. Patients were asymptomatic in 76.9% of cases (20/26). CONCLUSION Percutaneous retrieval of cardiovascular foreign bodies is a reasonable, safe, and effective way in children when the catheter fragments are free and mobile. It should be considered the preferred treatment option instead of surgery. In patients where catheter fragments are stuck and are adherent to vessels, it could be left, and followed up by anticoagulation. Novel techniques accompanied by an experienced team could be helpful in difficult cases.
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Affiliation(s)
- Derya Duman
- Department of Pediatric Cardiology, Mersin University, Mersin
| | | | | | - Burak Ardiçli
- Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey
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Kaazan P, Seow W, Tan Z, Logan H, Philpott H, Huynh D, Warren N, McIvor C, Holtmann G, Clark SR, Tse E. Deliberate foreign body ingestion in patients with underlying mental illness: A retrospective multicentre study. Australas Psychiatry 2023; 31:619-624. [PMID: 37473424 PMCID: PMC10566206 DOI: 10.1177/10398562231189431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Deliberate foreign body ingestion (DFBI) is characterised by recurrent presentations among patients with mental health conditions, intellectual disabilities and in prisoners. We aimed to profile the characteristics and evaluate the care of such patients in this study. METHODS Adult patients with an endoscopic record of attempted foreign body retrieval between January 2013 and September 2020 were identified at three Australian hospitals. Those with a documented mental health diagnosis were included and their standard medical records reviewed. Presentation history, demographics, comorbidities and endoscopic findings were recorded and described. RESULTS A total of 166 admissions were accounted for by 35 patients, 2/3 of which had borderline personality disorder (BPD). Repetitive presentations occurred in more than half of the cohort. There was an increased trend of hospital admissions throughout the years. At least half of the cohort had a documented mental health review during their admission. An average of 3.3 (2.9) foreign bodies were ingested per single episode. Endoscopic intervention was performed in 76.5% of incidents. The combined Length of stay for all patients was 680 days. CONCLUSION Deliberate foreign body ingestion in mental health patients is a common, recurring and challenging problem that is increasing in frequency and requires collaborative research to further guide holistic management.
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Affiliation(s)
- P Kaazan
- Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - W Seow
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; and
- Department of Gastroenterology and Hepatology, The Royal Adelaide Hospital, Adelaide, Australia
| | - Z Tan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - H Logan
- Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, Brisbane, Australia; and
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - H Philpott
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - D Huynh
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, Australia
| | - N Warren
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; and
- Addiction and mental health services, Brisbane, Metro South health
| | - C McIvor
- Department of Gastroenterology and Hepatology, Logan Hospital, Logan, Australia
| | - G Holtmann
- Department of Gastroenterology and Hepatology, The Princess Alexandra Hospital, Brisbane, Australia; and
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - S R Clark
- Faculty of Health and Medical Sciences, University of Adelaide, Brisbane, Australia; and
- Discipline of Psychiatry, Central Adelaide Local Health Network
| | - E Tse
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; and
- Department of Gastroenterology and Hepatology, The Royal Adelaide Hospital, Adelaide, Australia
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Akca Caglar A, Derinoz Guleryuz O, Tomar Güneysu S, Çolak Ö. Evaluation of Physicians' Knowledge About Honey/Sucralfate Treatments in Children With Button Battery Ingestion. Pediatr Emerg Care 2023; 39:797-800. [PMID: 37725763 DOI: 10.1097/pec.0000000000003046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Ingestion of button batteries (BBs) causes serious mortality and morbidity. We aimed to evaluate the knowledge level of physicians working in pediatric emergency departments about the updated guidelines for BB ingestion and whether they used honey and sucralfate, which have proven positive effects in preventing mucosal damage, in their daily practice. METHODS A "Google Form" questionnaire was prepared and used to evaluate the approach of physicians who worked in pediatric emergency department with questions about pediatric patients who were admitted with the suspicion of BB swallowing. RESULTS A total of 263 physicians, 169 women (64.3%), with a mean age of 34.5 ± 7.3 years, participated in the study. Seventy-five percent of the participants were from tertiary care hospitals, and 60.8% had less than 5 years of pediatric emergency experience. Some 71.9% of the physicians who participated in the survey (n = 189) had no algorithm at their hospitals. Fifty-eight percent (n = 152) of the participants completely and correctly answered all our survey questions about battery swallowing. Fifty-eight (22.1%) of the participants administered sucralfate, and 12.2% (n = 32) used honey treatments in patients who swallowed BBs; 68.1% (n = 179) had never heard of the use of sucralfate, and 77.6% (n = 204) had never heard of honey applications before in the management of swallowed batteries. CONCLUSION It was determined that the physicians who managed pediatric battery swallowing cases had deficiencies in their treatment approaches, they had no protocol in their institutions, and the use of mucosal damage mitigation and neutralization treatments, such as honey and sucralfate, was insufficient.
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Affiliation(s)
- Ayla Akca Caglar
- From the Pediatric Emergency Department, Gazi University, Ankara, Turkey
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Flórez Sarmiento C, Parra Izquierdo V, Frías Ordoñez JS, Castillo JD, Murcia Monroy E, Delgado Cardona L, Rodríguez CS. [Esophageal foreign bodies: review of 84 cases]. Rev Gastroenterol Peru 2023; 43:328-333. [PMID: 38228298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The presence of esophageal foreign body (EFB) is a common emergency in gastroenterology. The protocol for management and endoscopic intervention can be variable among institutions. OBJECTIVE to define the clinical characteristics of EFB in adults, its radiological and endoscopic diagnosis, and complications based on a sample of patients in a gastroenterology center. MATERIALS AND METHODS case series of patients admitted from the emergency department and referred to the gastroenterology department with a presumptive diagnosis of EFB. Clinical variables were collected, as well as characteristics, comorbidities, time of evolution and diagnostic opportunity, confirmatory studies, and complications. RESULTS 84 subjects, 70% men, mean age 45 (range: 17-87; SD 12.5) years. Urgent upper endoscopy was performed in 98.8% of the patients, with an average in-hospital stay of 2.5 days. 93% had no associated underlying pathology, in 6/84 (7.14%) patients structural or functional esophageal pathology was documented. 59/84 (70.2%) patients consulted in the first 24 hours, in 57.6% the presence of foreign body was confirmed endoscopically. In 67/84 (79.76%) patients radiography was performed prior to endoscopy, of which 62/67 (92.5%) had an abnormal result. Seventy percent of confirmed EFB were fish bones. The most frequent site of localization was in the cricopharyngeal region in 90% of the cases. In 66/84 (78.6%) subjects there was absence of complications, followed by deep laceration in 10/84 (11.9%) cases. In 3/84 (3.6%) cases complications requiring surgery were identified. CONCLUSIONS Endoscopic intervention in the first 24 hours is an opportune moment to identify complications and provide the indicated treatment.
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Affiliation(s)
- Cristian Flórez Sarmiento
- Gastroadvanced IPS. Bogotá Colombia; Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia. Bucaramanga, Colombia; Clínica Palermo. Bogotá, Colombia; Clínica Infantil Santa María del Lago. Bogotá Colombia
| | - Viviana Parra Izquierdo
- Gastroadvanced IPS. Bogotá Colombia; Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia. Bucaramanga, Colombia
| | | | - Jesús David Castillo
- Gastroadvanced IPS. Bogotá Colombia; Clínica Infantil Santa María del Lago. Bogotá Colombia
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Habib M, Arif K, Chaudhary MA. Characteristics And Outcomes Of Aerodigestive Foreign Bodies In Children. J Ayub Med Coll Abbottabad 2023; 35(Suppl 1):S726-S731. [PMID: 38406901 DOI: 10.55519/jamc-s4-12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Aerodigestive foreign bodies are common in children of pre-school-going age. It is one of the leading cause of morbidity and mortality in the paediatric population and a global health burden. Methods We present here data of 108 patients who presented to Children hospital's Emergency with a suspicion of foreign body ingestion/aspiration over 2 years from July 1st 2021 to 30th June 2023. Their descriptive analysis including, socio-demographics, type of foreign body, age of presentation, and mode of presentation were calculated and correlation was done using the Pearson Chi square test. Results We observed different types & characteristics of foreign bodies, patients were predominantly male with 62.26%. The mean age of presentation was 40.97 months. The majority of patients were of pre-school age, younger than 4 years (44.44%) followed by the infant population (19.44%) p=0.002. Foreign bodies were mainly located in the upper oesophagus for ingested FBs (60.8%). Most of the population presented within the first 5 hours (52.88%) followed by the first 12 hours (11.11%). Coin ingestion was by far the most common (54%) followed by button battery (19%) and the whistle was the most common aspirated object (33%). Conclusion All patients with a suspicion of foreign body ingestion/inhalation should be evaluated. Early recognition and treatment are imperative because the complications are serious and can be life-threatening and once confirmed should undergo endoscopic removal.
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Affiliation(s)
- Murad Habib
- Department of Paediatric Surgery, The Children's Hospital Pakistan Institute of Medical Sciences Islamabad, Pakistan
| | - Khurrum Arif
- Department of Paediatric Surgery, The Children's Hospital Pakistan Institute of Medical Sciences Islamabad, Pakistan
| | - Muhammad Amjad Chaudhary
- Department of Paediatric Surgery, The Children's Hospital Pakistan Institute of Medical Sciences Islamabad, Pakistan
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Antono D. A Mislocation of Double-lumen Catheter Guidewire in Right Atrium Successfully Retrieved with Loop-wire Snaring: A Case Report. Acta Med Indones 2023; 55:440-443. [PMID: 38213052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
The increasing rate of central vascular access use especially for hemodialysis access in Indonesia carries risk of retention of the guidewire to the heart resulting in a condition known as heart foreign bodies. We described a case of mislocation of double-lumen catheter guidewire to the right atrium in a patient planned to perform hemodialysis. The patient complained of dyspnea and swelling of extremities but the symptoms had already appeared before the insertion of the catheter due to the patient's underlying kidney disease arising conclusion that the foreign bodies itself are asymptomatic. The wire was found on chest x-ray and then confirmed on fluoroscopy during the retrieval procedure. Loop-wire was used to snare the guidewire. The wire was successfully evacuated and the patient was stable. The rare nature of the condition could become a challenge in recognizing the condition. Percutaneous retrieval is the preferred management of the condition.
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Affiliation(s)
- Dono Antono
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Ekim A, Altun A. Foreign body aspirations in childhood: A retrospective review. J Pediatr Nurs 2023; 72:e174-e178. [PMID: 37355460 DOI: 10.1016/j.pedn.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this study was to examine the childhood-age foreign body aspiration (FBA) retrospectively by focusing on symptoms, types, home interventions, hospitalization and complications. METHOD All patients between 0-18 years admitted to pediatric surgical clinic and diagnosed with FBA were examined retrospectively from January 2021 to January 2022. RESULTS The study group consisted of 163 patients and their mean age was 17.8±12.7 months (1 months to 6 years). FBA events included aspiration of food (78%), coins (10%), batteries (3.7%), parts of toys (4%), buttons (2.4%) and other (2%). First aid treatment to children was performed at home by mothers (61%). Types of first aid treatment performed by mothers included tapping the back (31%); cleaning inside the mouth (24%); trying to remove the foreign body with fingers (12%), pushing the foreign body forward (5.9%) and forcing the child to vomit (9.5%) respectively. CONCLUSIONS FBA is a potential life-threatening health problem during childhood. When the age of majority of patients being under one year old and prevalence of food in FBA types are taken into consideration, safe-feeding practices of mothers, feeding position and training about the safe-environment are the basic steps of prevention strategies. PRACTICE IMPLICATIONS One of the most useful ways of preventing FBA cases is to provide planned and continuing education to parents, care givers and all the individuals responsible for the care of the child in order to increase their knowledge and practice levels.
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Affiliation(s)
- Ayfer Ekim
- Faculty of Health Sciences, Department of Pediatric Nursing, Istanbul Arel University, Istanbul, Turkey..
| | - Aslıhan Altun
- Graduate Education Institute, Istanbul Arel University, Istanbul, Turkey
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Calini G, Ortolan N, Battistella C, Marino M, Bresadola V, Terrosu G. Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: an updated analysis in a European tertiary care hospital. Eur J Gastroenterol Hepatol 2023; 35:962-967. [PMID: 37395211 DOI: 10.1097/meg.0000000000002602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Harmfulness of foreign body ingestion and food bolus impaction (FBIs) varies according to geographical area, population, habits, and diet. Therefore, studies may not draw generalizable conclusions. Furthermore, data regarding FBIs management in Europe are limited and outdated. This study aimed to analyze the endoscopic management and outcomes of FBIs in an Italian tertiary care hospital to identify risk factors for endoscopic failure. METHODS We retrospectively reviewed patients who underwent upper gastrointestinal endoscopy for FBIs between 2007 and 2017. Baseline, clinical, FBIs, and endoscopic characteristics and outcomes were collected and reported using descriptive statistics and logistic regression analyses. RESULTS Of the 381 endoscopies for FBIs, 288 (75.5%) were emergent endoscopy and 135 (35,4%) included underlying upper gastrointestinal conditions. The study population included 44 pediatric patients (11.5%), 54 prisoners (15.8%), and 283 adults (74.2%). The most common type and location of FBIs were food boluses (52.9%) and upper esophagus (36.5%), respectively. While eight patients (2.1%) developed major adverse events requiring hospital admission, the remainder (97.9%) were discharged after observation. No mortality occurred. Endoscopic success was achieved in 263 of 286 (91.9%) verified FBIs endoscopies. Endoscopic failure (8.04%) was associated with age, bone, disk battery, intentional ingestion, razor blade, prisoners, and stomach in the univariate analysis. Multivariate logistic regression revealed that intentional ingestion was associated with endoscopic failure (odds ratio: 7.31; 95% confidence interval = 2.06-25.99; P = 0.002). CONCLUSION Endoscopy for FBIs is safe and successful, with low hospital admission rate in children, prisoners, and adults. Intentional ingestion is a risk factor of endoscopic failure.
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Affiliation(s)
- Giacomo Calini
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | | | - Claudio Battistella
- Department of Medical and Biological Sciences, Section of Statistics, University of Udine
| | - Marco Marino
- Gastroenterology and GI Endoscopy Unit, University Hospital of Udine, Udine, Italy
| | - Vittorio Bresadola
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
| | - Giovanni Terrosu
- Department of Surgery, University Hospital 'Santa Maria della Misericordia', University of Udine
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Wang Y, Chang Q. Rare cardiac foreign body: acupuncture needle-penetrated heart. Eur Heart J Cardiovasc Imaging 2023; 24:e274. [PMID: 37294558 DOI: 10.1093/ehjci/jead134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Yikang Wang
- Department of cardiovascular surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266003, China
| | - Qing Chang
- Department of cardiovascular surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266003, China
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Lorenzo M, Beno S. Evolving threat of pediatric ingestions: a discussion of cannabis and button batteries and their implications for children. Curr Opin Pediatr 2023; 35:316-323. [PMID: 36876321 DOI: 10.1097/mop.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
PURPOSE OF REVIEW Pediatric button battery and cannabis ingestions are rising in incidence and have the potential for significant harm. This review will focus on the clinical presentation and complications of these two common inadvertent ingestions in children, as well as recent regulatory efforts and advocacy opportunities. RECENT FINDINGS The rising incidence of cannabis toxicity in children has corresponded with its legalization across several countries in the last decade. Inadvertent pediatric cannabis intoxication is most commonly due to the ingestion of edible forms discovered by children in their own home. The clinical presentation can be nonspecific, therefore clinicians should have a low threshold for including it on their differential diagnosis. Button battery ingestions are also increasing in incidence. While many children are asymptomatic at presentation, button battery ingestions can quickly cause esophageal injury and lead to several serious and potentially life-threatening complications. Prompt recognition and removal of esophageal button batteries is essential for reducing harm. SUMMARY Cannabis and button battery ingestions are important for physicians who take care of children to recognize and manage appropriately. Given their rising incidence, there are many opportunities for policy improvements and advocacy efforts to make a difference in preventing these ingestions altogether.
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Affiliation(s)
- Melissa Lorenzo
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Uğur C, Yüksel F. Analysis of Ear Nose Throat Consultations Requested From the Pediatric Emergency Service in a Tertiary Hospital. Pediatr Emerg Care 2023; 39:342-346. [PMID: 36706230 DOI: 10.1097/pec.0000000000002911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study is to examine the reasons and the methods of approach to the patients for the ear nose and throat (ENT) consultations requested from the patients who applied to the pediatric emergency department. METHODS The files of 351 patients who applied to the pediatric emergency outpatient clinic and were asked for consultation from the ENT clinic were reviewed retrospectively. Demographic data, complaints on admission, diagnostic examinations, diagnoses, treatment methods, and hospitalizations were recorded. RESULTS Of the patients included in the study, 190 (54.1%) were female and 161 (45.9%) were male. The median age of the patients was 4.0 years (3.0-8.0 years). The most common diagnoses after ENT examination are; 120 patients (34.2%) had foreign body (FB) in the nose, 58 patients (16.5%) had FB in the ear, 16 patients (4.6%) had FB in the throat, 16 patients (4.6%) had epistaxis, and 15 patients (4.3%) had Bell's palsy. According to age group, it was determined that FB in the nose and ear was more common in the 0- to 5- and 6- to 11-year age group, and Bell's palsy, FB in the ear and epistaxis were more common in the 12- to 17-year age group. A normal examination was also an important finding in 83 of the patients (23.6%). CONCLUSIONS Foreign bodies are the most common reason for admission to the emergency services in children, and it is frequently seen between 0 and 5 years of age. Informing and raising awareness of parents on this topic will reduce both unwanted complications and ENT consultations along with admission to pediatric emergency services.
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Affiliation(s)
- Cüneyt Uğur
- From the Department of Pediatrics, University of Health Sciences Turkey, Konya City Health Application and Research Center
| | - Fatih Yüksel
- Department of Otorhinolaryngology, Konya City Hospital, Konya, Turkey
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Sinclair EM, Agarwal M, Santore MT, Sauer CG, Riedesel EL. Single-Center Retrospective Review of the Presentation and Initial Care of Esophageal Button Battery Impactions 2007-2020. Pediatr Emerg Care 2023; 39:259-264. [PMID: 35353766 PMCID: PMC9519803 DOI: 10.1097/pec.0000000000002690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to characterize the patient population and initial presentation and care of esophageal button battery ingestion and provide descriptive data including factors affecting accurate diagnosis, duration of battery exposure, and battery removal. METHODS This was a retrospective cohort study from 2007 to 2020 at a single-center, large-volume, urban academic pediatric hospital system. Included participants were children 6 months to 18 years old who underwent removal of an esophageal button battery impaction at our institution. RESULTS Our cohort comprised 63 patients; ages ranged from 7 to 87 months with a median of 27 months. Median button battery size was 2.12 cm with 59% lodged in the proximal esophagus. A prolonged impaction, greater than 12 hours, occurred in 46% of patients. Risk ratio analysis demonstrated that lack of caregiver suspicion of ingestion was associated with prolonged impaction (risk ratio, 3.39; confidence interval, 2.15-5.34). Misdiagnosis of button battery ingestion occurred in 10% of cases. The majority of patients, 87%, required transfer from a referring facility with a median total distance of 37 miles (range, 1.4-160 miles) from home to facility where battery was removed. CONCLUSION AND RELEVANCE This study describes the initial presentation and care of a large cohort of pediatric esophageal button battery ingestion. It emphasizes the continued need for primary prevention, prompt identification, and removal of these batteries. There are many challenges in caring for these patients involving multiple pediatric disciplines, and guidelines encompassing a multidisciplinary approach would be beneficial.
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Affiliation(s)
| | - Maneesha Agarwal
- Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Department of Pediatrics
| | - Matthew T Santore
- Pediatric Surgery, Children's Healthcare of Atlanta, Department of Surgery and Pediatrics
| | | | - Erica L Riedesel
- Pediatric Radiology, Children's Healthcare of Atlanta, Department of Radiology and Pediatrics, Emory University School of Medicine, Atlanta, GA
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Yan S, Jiang P, Chen G, Chen Y, Pan H, Li L, Zeng N. Characteristics and Treatment of Pediatric Tracheobronchial Foreign Bodies: A Retrospective Analysis of 715 Cases. Med Sci Monit 2022; 28:e937928. [PMID: 36372993 PMCID: PMC9673461 DOI: 10.12659/msm.937928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/17/2022] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND This study aimed to analyze the clinical characteristics of tracheobronchial foreign bodies in children in Shenzhen and to explore the diagnosis and treatment methods for special cases. MATERIAL AND METHODS This study included a total of 715 children who were diagnosed with tracheobronchial foreign bodies at Shenzhen Children's Hospital between October 2016 and October 2021. Data on sex, age, inducement, symptoms, foreign body type, foreign body location, foreign body retention time, foreign body history, and complications were recorded and analyzed. RESULTS Tracheal foreign bodies were found to occur primarily in children aged 0-2 years (90.6%). The overall incidence rates were 69.1% and 30.9% in boys and girls, respectively. Among them, 42.5% of the foreign bodies were detected in the left bronchus and 45.6% in the right bronchus. Inducements included playing while eating (n=398, 55.7%) and also crying (n=209, 29.2%). Operations were performed on 710 (99.3%) children, including 80 (11.2%) immediate surgeries and 2 tracheotomies. One child had no vital signs upon admission and died after emergency foreign body removal. All of the other children who underwent surgery recovered well postoperatively. CONCLUSIONS This study presents the characteristics and methods of diagnosis and treatment of tracheobronchial foreign bodies in pediatric patients in Shenzhen. Tracheobronchial foreign bodies are a major cause of accidental injury in infants and young children. In critical cases, airways should be immediately and rapidly cleared with multidisciplinary collaboration. In addition, public safety awareness should be strengthened, particularly among parents, teachers, and other child caregivers, to reduce and prevent instances of tracheobronchial foreign body accidents in children.
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Affiliation(s)
- Shang Yan
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, PR China
| | - Peng Jiang
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, PR China
| | - Guowei Chen
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, PR China
| | - Yongchao Chen
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, PR China
| | - Hongguang Pan
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, PR China
| | - Lan Li
- Department of Otolaryngology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, PR China
| | - Nan Zeng
- Department of Otolaryngology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, Guangdong, PR China
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Duan M, Morvil G, Badron J, Ganapathy S. Epidemiological trends and outcomes of children with aural foreign bodies in Singapore. Ann Acad Med Singap 2022; 51:351-356. [PMID: 35786755 DOI: 10.47102/annals-acadmedsg.2021319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Aural foreign bodies (FBs) are a common presenting complaint in emergency departments (EDs) worldwide. This study aims to describe trends and outcomes of aural FBs in the paediatric population, presenting to a tertiary hospital in Singapore. METHODS A retrospective review of medical records was conducted of all children 0-16 years old with aural FBs who presented to KK Women's and Children's Hospital ED from 2013 to 2017. Clinical data that were collected include patient demographics, type of FB, ear compartment and laterality of FB, symptoms, duration of impaction, mode of removal, outcome in ED, and final disposition. RESULTS There were a total of 1,003 cases. The largest age group consisted of 53.7% preschool children of 0-6 years. Males (61.7%) were more common than females (38.3%). FBs were predominantly organic materials (25.6%), followed by beads and stones (15.2%). Most FBs were found in the right ear (56.6%). The majority of patients were asymptomatic (62%). Symptoms observed included ear pain (20.1%), itch (4.8%) and bleeding (3.2%). FBs were removed by instruments (36.6%), suctioning (15.4%), syringing (8.2%), or a combination of methods (13.7%). In the ED, 73.9% of patients had an attempt at removal, among which 78.4% of FBs were successfully removed, 5.9% required specialist review, and 15.7% were unsuccessful. CONCLUSION The majority of paediatric aural FBs can be successfully removed in the ED. Emergency physicians should be trained and equipped with the relevant skills to remove aural FBs.
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Affiliation(s)
- Menghao Duan
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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Bettadahalli V, Kumar S, Shukla I, Nair R, Kumar P. Evolving Trends of Button Battery Ingestion in Indian Children at a Tertiary Care Hospital. Pediatr Emerg Care 2022; 38:e1201-e1206. [PMID: 34620806 DOI: 10.1097/pec.0000000000002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Foreign body ingestion is a common problem encountered in the pediatric age group. Impaction of lithium batteries of greater than 20-mm diameter in the esophagus is associated with severe complications. This study aimed at analyzing the evolving trends of button battery ingestion in pediatric age groups at our tertiary care center in terms of clinical presentation, intraoperative findings, and the correlation of various clinical variables. METHODS A retrospective observational study was done. All children younger than 18 years with impaction of a button battery of size greater than 20 mm in the esophagus between January 2015 and December 2018 were included in the study. All children underwent removal of the battery using direct laryngoscopy/rigid esophagoscopy under general anesthesia. RESULTS There were 100 children included in the study with a mean age of 29.92 months having 93 children (93%) younger than 6 years. The mean duration of impaction was 34.7 hours. Increased duration of impaction was associated with an increased risk of complications and an increased difficulty in removal. There was a significant correlation between the site of impaction and the age of the patient. Complications were seen in 10% of cases with severe complications in 6 cases. No fatalities were reported in this study. CONCLUSIONS Button batteries impacted in the esophagus can lead to severe complications including death. There has been an increasing trend in the ingestion of button batteries over the last 4 years. A prompt diagnosis and emergent removal of the battery are crucial to minimize the rate of complications. Symptoms of stridor and dysphagia must be given more attention, and these children are prioritized because they are more prone to have complications. Furthermore, primary prevention and caregiver education should be emphasized, and the need for a legislation to change the policies for securing the batteries in their products must be endorsed.
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Affiliation(s)
- Vishaka Bettadahalli
- From the Department of ENT, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Norfolk, United Kingdom
| | - Sunil Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Indu Shukla
- Department of Otorhinolaryngology and Head Neck Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Rohini Nair
- Department of Otorhinolaryngology and Head Neck Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Poornima Kumar
- Department of Otorhinolaryngology and Head Neck Surgery, Lady Hardinge Medical College, New Delhi, India
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Dunne CL, Osman S, Viguers K, Queiroga AC, Szpilman D, Peden AE. Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis. Int J Environ Res Public Health 2022; 19:ijerph19073846. [PMID: 35409529 PMCID: PMC8998090 DOI: 10.3390/ijerph19073846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient’s age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2−80) and 73 (Dechoker©, 5−84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms.
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Affiliation(s)
- Cody L. Dunne
- Department of Emergency Medicine, University of Calgary, Calgary, AB T2N2T9, Canada
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- Correspondence:
| | - Selena Osman
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N4N1, Canada;
| | - Kayla Viguers
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1C5S7, Canada;
| | - Ana Catarina Queiroga
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4200-319 Porto, Portugal
| | - David Szpilman
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- Brazilian Lifesaving Society (SOBRASA), Barra da Tijuca, Rio de Janeiro 22631-004, Brazil
| | - Amy E. Peden
- International Drowning Researchers’ Alliance, Kuna, ID 83634, USA; (A.C.Q.); (D.S.); (A.E.P.)
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
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Sinclair EM, Santore MT, Agarwal M, Kitzman J, Sauer CG, Riedesel EL. Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care. J Pediatr Gastroenterol Nutr 2022; 74:236-243. [PMID: 34724451 PMCID: PMC8799493 DOI: 10.1097/mpg.0000000000003346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Esophageal button battery impactions (BBI) in children pose a significant danger to children. Although there are expert-opinion guidelines to help manage this population, few studies detail the impact of guidelines on the clinical care of these patients. With this study, we aimed to describe the care of these patients before and following adoption of guidelines at a single center. METHODS Retrospective cohort study of patients with esophageal BBI at a single center, large volume, urban academic pediatric hospital system before adoption of expert-opinion guidelines (2007-2017) and following adoption (2018-2020). RESULTS Cohort was comprised of 31 patients before adoption and 32 patients following adoption of guidelines. Patient characteristics did not differ between groups. After 2018, significantly more patients received acetic acid irrigation, initial cross-sectional imaging, and serial cross-sectional imaging. There was also an increase in intensive care unit (ICU) stays, number of intubations, nil per os time, and hospital length of stay. There was no difference in patient outcomes. CONCLUSION This study describes a large cohort of pediatric esophageal BBI before and following adoption of guidelines. Findings detail increased adherence to guidelines resulting in more cross-sectional imaging which led to ICU stays, longer length of stays, and more nil per os time. This study emphasizes the need for multi-disciplinary guidelines as well as further multi-institutional study.
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Affiliation(s)
| | | | | | - Jamie Kitzman
- Pediatric Anesthesiology, Department of Anesthesiology and Pediatrics
| | - Cary G Sauer
- Pediatric Gastroenterology, Department of Pediatrics
| | - Erica L Riedesel
- Pediatric Radiology, Department of Radiology and Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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Liao F, Zhu Z, Pan X, Li B, Zhu Y, Chen Y, Shu X. Safety and Efficacy of Nonoperative Treatment in Esophageal Perforation Caused by Foreign Bodies. Clin Transl Gastroenterol 2022; 13:e00451. [PMID: 35060929 PMCID: PMC8806378 DOI: 10.14309/ctg.0000000000000451] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this study was to investigate the safety and efficacy of nonoperative treatment of esophageal perforation caused by foreign bodies. METHODS We retrospectively analyzed 270 patients admitted to our hospital for esophageal perforation caused by foreign bodies from January 2012 to December 2020, all of whom received nonoperative treatment. RESULTS The mean age of the patients was 56 ± 17 years, and fish bones were the most common type of foreign body. A total of 61.2% of the perforations were in the cervical esophagus. All patients received nonoperative treatment initially, and the foreign body removal rate using endoscopy reached 97%. The perforation healing rate reached 94.8%, whereas 3 patients (1.1%) died during hospitalization. The median (range) duration of hospitalization was 4 days (3-6). Multivariable analysis showed age ≥ 66 years (odds ratio [OR]: 2.196; 95% confidence interval [CI]: 1.232-3.916; P = 0.008), men (OR: 1.934; 95% CI: 1.152-3.246; P = 0.013), and time to treatment (OR: 1.126; 95% CI: 1.027-1.233; P = 0.011) were independent risk factors for infection, whereas the risk of infection was lower when the foreign body type was fish bone (OR: 0.557; 95% CI: 0.330-0.940; P = 0.028). DISCUSSION Nonoperative treatment is safe and effective for esophageal perforation caused by foreign bodies. Even if perforation is combined with infection, active nonoperative treatment can still achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.
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Affiliation(s)
- Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhenhua Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaolin Pan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bimin Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Cho EH, Shim L, Choi HG, Hong SK, Kim HJ, Lee HJ. Foreign Body Complications in Ears due to Mishandled Hearing Aid Fitting and Proposed Clinical Guidelines to Address the Complications. J Korean Med Sci 2022; 37:e19. [PMID: 35014230 PMCID: PMC8748667 DOI: 10.3346/jkms.2022.37.e19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND South Korea has one of the world's fastest aging populations and is witnessing increased age-related hearing impairment cases as well as an increase in the number of hearing aid users. The aim of this study was to analyze complications caused by hearing aid mold materials. In addition, we hope to raise awareness of the harm and danger that inexperienced hearing aid providers can cause to patients. METHODS We retrospectively reviewed the medical records of 11 patients who were diagnosed with hearing aid mold material as a foreign body in the ear at a tertiary center between 2016 and 2020. The following data were analyzed: symptoms, endoscopic findings, audiometry, temporal bone CT images, treatment methods, and complications after removal. The currently available literature was also reviewed to develop clinical guidelines, to identify the systematic weaknesses in the South Korean hearing aid market, and to identify policies that warrant better quality control. RESULTS Among the 11 cases, 9 were restricted to the external auditory canal, all of which were successfully removed under endoscopy with minor complications. Two cases with middle ear involvement resulted in infection and thus required surgical removal with mastoidectomy. The average age of these patients was 76.4, and all patients received their molding procedure at private hearing aid shops without an otolaryngologist's examination. CONCLUSION Thorough patient history-taking and otologic examination must be performed to identify patients at higher risk of complications. Such patients should be referred to an otolaryngologist. If a patient exhibits alarming symptoms, early referral is critical since prompt surgery can minimize complications. A CT scan is highly recommended to determine an optimal approach for foreign body removal. Systematic and regulatory changes in hearing aid dispensers, such as requiring apprenticeship, raising the required level of education, and legally mandating referrals, can help reduce these complications.
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Affiliation(s)
- Eun-Hyun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Leeseul Shim
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Sung Kwang Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
- Laboratory of Brain & Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang, Korea.
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Shafiq S, Devarbhavi H, Balaji G, Patil M. Button battery ingestion in children: Experience from a tertiary center on 56 patients. Indian J Gastroenterol 2021; 40:463-469. [PMID: 34613568 DOI: 10.1007/s12664-021-01192-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/03/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM The ubiquitous use of portable electronic devices has resulted in an increased incidence of button battery (BB) ingestion in children. BB ingestion represents a distinct category of ingested foreign body due to the associated high morbidity and mortality. The aim of this study was to report our experience in the management of BB ingestion in children. METHODS We reviewed the clinical and endoscopic characteristics of 56 children (≤ 18 years) who presented to our hospital emergency department (ED) with BB ingestion between December 2016 and November 2019. Data with respect to patient demographics, time of presentation to ED to endoscopic retrieval of BB, the endoscopic findings, and complications, if any, were collected. RESULTS We encountered a total of 56 children with BB ingestions. While 10 BBs passed off spontaneously without any complication, 27 BBs were extracted endoscopically from the stomach. A total of 19 BB impactions occurred: 9 at the cricopharynx/upper esophageal sphincter (UES), 5 in the mid esophagus, 4 in the lower esophagus, and one at the pyloric ring. All impactions occurred with larger BBs (diameter ≥ 10 mm). Complications occurred in 3 children (5.35%) following retrieval; 2 developed upper esophageal strictures on follow-up, which were treated with serial dilations and one experienced esophageal perforation and peritonitis requiring laparotomy. There was no mortality in our study. CONCLUSIONS A vast majority of ingested BBs pass off spontaneously or require minimal endoscopic intervention. Serious complications arise in a small minority especially in BBs > 10 mm in size with a potential for esophageal impaction.
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Affiliation(s)
- Syed Shafiq
- Department of Medical Gastroenterology, St. John's Medical College Hospital, Sarjapur Road, Bengaluru, 560 034, India.
| | - Harshad Devarbhavi
- Department of Medical Gastroenterology, St. John's Medical College Hospital, Sarjapur Road, Bengaluru, 560 034, India
| | - Gurappa Balaji
- Department of Gastroenterology, Fortis Hospital, 154, 9, Bannerghatta Main Road, Sahyadri Layout, Bilekahalli, Bengaluru, 560 076, India
| | - Mallikarjuna Patil
- Department of Medical Gastroenterology, St. John's Medical College Hospital, Sarjapur Road, Bengaluru, 560 034, India
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Pantazopoulos I, Mavrovounis G, Mermiri M, Adamou A, Gourgoulianis K. Intentional ingestion of batteries and razor blades by a prisoner: a true emergency? Int J Prison Health 2021; 18:316-322. [PMID: 34549561 DOI: 10.1108/ijph-06-2021-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Few case studies in the literature report on adult patients with intentional foreign body ingestion. Prisoners deliberately ingest foreign bodies, such as cylindrical alkaline batteries and razor blades, to achieve hospitalization or commit suicide. The purpose of this paper is to present a case of deliberate ingestion of batteries and razor blades by an inmate. DESIGN/METHODOLOGY/APPROACH The authors present a case of an incarcerated man in Greece, who intentionally ingested three cylindrical alkaline batteries and three razor blades wrapped in aluminum foil. FINDINGS The patient was treated conservatively with serial radiographs and was subsequently discharged without complication. This paper discusses the complications and examine the current guidelines available. ORIGINALITY/VALUE To best of authors' knowledge, this is the first report of a simultaneous ingestion of batteries and razor blades.
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Affiliation(s)
| | | | - Maria Mermiri
- Department of Emergency Medicine, University of Thessaly Volos Greece
| | - Antonis Adamou
- Department of Radiology, University of Thessaly Volos Greece
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Ponnuvelu K, Saniasiaya J, Abdul Gani N. Intriguing aural foreign body and algorithm of management of foreign body. BMJ Case Rep 2021; 14:e242122. [PMID: 34400422 PMCID: PMC8370545 DOI: 10.1136/bcr-2021-242122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/04/2022] Open
Abstract
Foreign body (FB) in the external auditory canal is more common among the paediatric age group compared with adult patients and it may be deposited in various ways. An accidental animate aural FB is reported to be commonly encountered in adults whereas inanimate FBs are likely to be found among adult patients with learning disability. An elderly man presented with accidental penetration of rattan tree stem into his ear while gardening. Removal of a FB from the external auditory canal requires expertise as deep penetration of a FB into the middle and inner ear may lead grave complications, especially when overzealous removal is attempted by nonear, nose and throat (ENT) personnel. This case emphasises on the importance of awareness of meticulous removal of a FB under proper visualisation so as to avoid unnecessary complications. Additionally, we propose an algorithm for proper removal of aural FB in an acute care setting.
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Affiliation(s)
- Komalar Ponnuvelu
- Department of Otorhinolaryngology, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Yogev D, Bar Moshe Y, Tovi H, Rekhtman D. Paroxysmal Upper Airway Obstruction Caused by Two Magnetic Balls. Isr Med Assoc J 2021; 23:325-326. [PMID: 34024052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Dotan Yogev
- Department of Pediatrics, Hadassah University Hospital, Mt. Scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yehonatan Bar Moshe
- Department of Radiology, Hadassah University Hospital, Mt. Scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Hodaya Tovi
- Department of Otolaryngology, Hadassah University Hospital, Mt. Scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - David Rekhtman
- Department of Pediatric Emergency Medicine, Hadassah University Hospital, Mt. Scopus, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Middelberg LK, Funk AR, Hays HL, McKenzie LB, Rudolph B, Spiller HA. Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019. J Pediatr 2021; 232:251-256.e2. [PMID: 33516676 DOI: 10.1016/j.jpeds.2021.01.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine, using the National Poison Data System (the data warehouse for poison control centers in the US), magnet foreign body injuries in pediatric patients. We sought to report demographic data, outcome data, and case trends between 2008 and 2019. STUDY DESIGN We conducted a retrospective analysis of the National Poison Data System for patients younger than 19 years of age with a magnet "exposure," which poison centers define as an ingestion, inhalation, injection, or dermal exposure to a poison. RESULTS A total of 5738 magnet exposures were identified. Most were male (3169; 55%), <6 years old (3572; 62%), with an unintentional injury (4828; 84%). There were 222 patients (3.9%) with a confirmed medical "effect," defined as signs, symptoms, and clinical findings not including therapeutic interventions (eg, endoscopy). There was a 33% decrease in cases from 418 (2008-2011) to 281 per year (2012-2017) after high-powered magnet sets were removed from the market. Calls subsequently increased 444% to 1249 per year (2018-2019) after high-powered magnet sets re-entered the market. Cases from 2018 and 2019 increased across all age groups and account for 39% of magnet cases since 2008. CONCLUSIONS Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018. These results reflect the increased need for preventative or legislative efforts.
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Affiliation(s)
- Leah K Middelberg
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH.
| | - Alexandra R Funk
- Nationwide Children's Hospital, Columbus, OH; Central Ohio Poison Center, Columbus, OH
| | - Hannah L Hays
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Central Ohio Poison Center, Columbus, OH
| | - Lara B McKenzie
- Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; Division of Epidemiology, Ohio State University College of Public Health, Columbus, OH
| | - Bryan Rudolph
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Henry A Spiller
- Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH; Central Ohio Poison Center, Columbus, OH
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Liu Y, Liu Z, Zha Y, Yu X. Supraglottic foreign body in a woman with Down's syndrome and congenital heart disease: A case report. Medicine (Baltimore) 2021; 100:e25455. [PMID: 33832154 PMCID: PMC8036037 DOI: 10.1097/md.0000000000025455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE An impacted foreign body (FB) in the larynx of an adult is a rare but potentially life-threatening occurrence. Patients with Down's syndrome (DS) are vulnerable to airway FB. However, the anesthesia for FB removal can be challenging. This report describes a case in which a FB was impacted between the vestibular folds in an adult with DS, congenital heart disease, and a difficult airway. PATIENT CONCERNS A 41-year-old woman swallowed a piece of sharp-tipped wooden skewer presented with a sudden onset of aphonia, dysphagia, and an acute sore throat without respiratory difficulty. The patient had DS, congenital heart disease, pulmonary arterial hypertension, and severe obstructive sleep apnea-hypopnea syndrome. The airway evaluation indicated that ventilation and intubation would be difficult due to retrognathia, macroglossia, adenotonsillar hypertrophy, and Mallampati's classification III. DIAGNOSIS The clinical symptoms and laboratory examination confirmed FB penetrated between the vestibular folds. INTERVENTIONS After careful multidisciplinary preoperative assessment and preparation, the FB was removed successfully by direct laryngoscopy under moderate sedation and spontaneous ventilation, with the application of 1% lidocaine as topical anesthesia. OUTCOMES The laryngeal FB was removed successfully without any complications. And the patient was discharged home the next day. LESSONS This case report shows the importance of anesthetic depth for laryngeal FB removal. The use of moderate sedation (allowing spontaneous ventilation) and adequate analgesia combined with local anesthesia enabled the patient to withstand the stress of direct laryngoscopy. Appropriate assessment, careful preparation, and multidisciplinary collaboration yielded the smooth removal of a laryngeal FB in an adult with DS.
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Affiliation(s)
| | | | - Yang Zha
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Affiliation(s)
- Marjolein van Waas
- Department of Paediatric Gastroenterology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Pauline De Bruyne
- Department of Paediatric Gastroenterology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Lissy de Ridder
- Department of Paediatric Gastroenterology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
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Zhang S, Zhang L, Chen Q, Zhang Y, Cai D, Luo W, Chen K, Pan T, Gao Z. Management of magnetic foreign body ingestion in children. Medicine (Baltimore) 2021; 100:e24055. [PMID: 33466161 PMCID: PMC7808496 DOI: 10.1097/md.0000000000024055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0-4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0-5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0-8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25-11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0-10.75] vs 3.5 [IQR: 2.0-4.0], P < .05). The risk of intestinal perforation was significantly higher in symptomatic patients (P < .05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6 days. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.
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Liu B, Ding F, An Y, Li Y, Pan Z, Wang G, Dai J, Li H, Wu C. Occult foreign body aspirations in pediatric patients: 20-years of experience. BMC Pulm Med 2020; 20:320. [PMID: 33298020 PMCID: PMC7724703 DOI: 10.1186/s12890-020-01356-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/22/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. METHODS Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. RESULTS Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n = 25, 71.4%). Coughing (n = 35, 100%) and wheezing (n = 18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n = 10) and the most common inorganic foreign bodies were pen caps (n = 5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. CONCLUSIONS Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.
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Affiliation(s)
- Bo Liu
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
- Chongqing Key Laboratory of Pediatrics; Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, PR China.
| | - Fengxia Ding
- Chongqing Key Laboratory of Pediatrics; Chongqing Engineering Research Center of Stem Cell Therapy, Chongqing Medical University, Chongqing, PR China
- Department of Respiratory Medicine; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yong An
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Zhengxia Pan
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Gang Wang
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Jiangtao Dai
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Chun Wu
- Department of Cardiothoracic Surgery; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
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Maiers TJ, Abramowitz DJ, Pominville R, Myneni AA, Noyes K, Bodkin Iii JJ. Management of genitourinary foreign bodies in a predominantly incarcerated population. Can J Urol 2020; 27:10444-10449. [PMID: 33325346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED INTRODUCTION Genitourinary foreign body (FB) insertion is a rare occurrence. Commonly reported reasons for insertion include autoeroticism and intoxication, however psychiatric illness is thought to contribute in most cases. In the incarcerated population, malingering plays a prominent role. We examined clinical patient characteristics and management patterns for cases of genitourinary FB insertion and sought to identify risk factors for recidivism. MATERIALS AND METHODS A retrospective review was performed of all patients presenting to a tertiary trauma center with a genitourinary FB between January 2001-June 2019. Patient demographics, presentation, work up, and management were reviewed. Bivariate and multivariate statistical analyses were performed. RESULTS Patients were primarily young (33 yo, range: 21-93), male (92%), incarcerated (67%), and had at least one psychiatric diagnosis (71%). Concomitant FB ingestion was present in 56 (41.5) encounters. Risk factors for repeat FB insertion included incarceration (100.0% versus 51.5%, p = < 0.01), psychiatric comorbidity (100.0% versus 51.5%, p = < 0.01), and other concomitant FB insertion/ingestion (68.7% versus 18.2%, p = < 0.01). Common methods of FB extraction included flexible cystoscopy (33.8%), extrinsic pressure (21.0%), rigid cystoscopy (12.8%), and open surgery (8.1%). Fifty-three (39.2%) encounters required anesthesia and 64 (47.4%) encounters required admission. CONCLUSIONS Genitourinary FBs are usually removed via endoscopic or minimally invasive extraction techniques and the majority are located within the anterior urethra. Special consideration should be given to patients with psychiatric comorbidity, concomitant FB insertion/ingestion, or those presenting from a correctional facility as these characteristics are associated with repeat insertion attempts.
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Affiliation(s)
- Tyler J Maiers
- Department of Urology, Buffalo General Medical Center, Buffalo, New York, USA
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Xiao CC, Kshirsagar RS, Rivero A. Pediatric foreign bodies of the ear: A 10-year national analysis. Int J Pediatr Otorhinolaryngol 2020; 138:110354. [PMID: 33152957 DOI: 10.1016/j.ijporl.2020.110354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the incidence of emergency department visits for pediatric ear foreign bodies. To identify the most common items and their trends. METHODS The Nationwide Electronic Injury Surveillance System (NEISS) was queried for emergency department visits involving the diagnosis of foreign bodies in the ear including pinna and canal in children over the most recent 10-year span available. National incidence estimates and demographic data were extracted from the same database. RESULTS Ear foreign bodies in children made up an estimated total 446,819 ED visits nationwide over the past 10 years. The mean age was 7.2 ± 4.3 years old. The majority (55.6%, n = 248,531) of cases were female. The most common class of objects found was jewelry, primarily embedded earrings and beads, accounting for 55.5% visits, followed by paper products at 7.1%, pens and pencils at 4.1%, desk supplies (erasers) at 3.7%, BBs or pellets at 3.5%, and earplugs and earphones at 3%. Females were significantly more likely to have jewelry foreign bodies, and males were significantly more likely to have foreign bodies from all other categories other than first-aid supplies. CONCLUSION Foreign bodies of the ear are a common reason for emergency department visits in children, primarily jewelry, paper products, and desk supplies. Recognition of commonly encountered objects can aid in both speedier recognition of unknown objects, as well as guide patient counseling.
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Affiliation(s)
- Christopher C Xiao
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, United States.
| | - Rjiul S Kshirsagar
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, United States
| | - Alexander Rivero
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, United States
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Couper K, Abu Hassan A, Ohri V, Patterson E, Tang HT, Bingham R, Olasveengen T, Perkins GD. Removal of foreign body airway obstruction: A systematic review of interventions. Resuscitation 2020; 156:174-181. [PMID: 32949674 DOI: 10.1016/j.resuscitation.2020.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/06/2020] [Accepted: 09/09/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To summarise in a systematic review the effectiveness of interventions to treat foreign body airway obstructions (FBAO). METHODS We searched MEDLINE, EMBASE, and the Cochrane library from inception on 30th September 2019 for studies that described the effectiveness of interventions to treat FBAO in adults and children. We included randomised controlled trials, observational studies and case series (≥5 cases) that described evidence of benefit. For evidence of harm/complications, we included case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias. Data are summarised in a narrative synthesis. The GRADE system is used to assess evidence certainty. RESULTS We included 69 publications, comprising three cross-sectional studies (557 patients); eight case series (755 patients), and 59 were case reports (64 patients). One paper was included as a case series and cross-sectional study. For all interventions and associated outcomes, evidence certainty was very low. Early removal of FBAO by bystanders was associated with improved neurological survival (odds ratio 6.0, 95% confidence interval 1.5 to 23.4). Identified evidence showed that key interventions (back blows, abdominal thrusts, chest thrusts/compressions, Magill forceps, manual removal of obstructions from the mouth, suction-based airway clearance devices) are effective in relieving FBAO. We identified reports of harm in relation to back blows, abdominal thrusts, chest thrusts/compressions, and blind finger sweeps. CONCLUSIONS Key interventions successfully relieve FBAO, but may be associated with important harms. Guidelines for FBAO management should balance the benefits and harms of interventions.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Vrinda Ohri
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma Patterson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ho Tsun Tang
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Robert Bingham
- Paediatric Anaesthetisia, Great Ormond Street Hospital for Children, London, UK
| | - Theresa Olasveengen
- Department of Anaesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Abstract
Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.
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Affiliation(s)
- Sung Bum Kim
- Division of Gastroenterology and Hepatology, Department of Internal medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kook Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal medicine, Yeungnam University College of Medicine, Daegu, Korea
- Correspondence to Kook Hyun Kim, M.D. Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3576 Fax: +82-53-654-8386 E-mail:
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Saltiel J, Molinsky R, Lebwohl B. Predictors of Outcomes in Endoscopies for Foreign Body Ingestion: A Cross-Sectional Study. Dig Dis Sci 2020; 65:2637-2643. [PMID: 31907772 DOI: 10.1007/s10620-019-06033-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND As foreign body ingestion/food impaction is one of the less common indications for upper endoscopy in adults, few studies have investigated outcomes. We aimed to determine the distribution of ingested items warranting endoscopy and to identify factors associated with successful endoscopic retrieval. METHODS We conducted a retrospective, cross-sectional study, identifying all endoscopies performed between June 2006 and June 2018 for foreign body ingestion or food impaction. We performed univariate and multivariate analyses to identify variables associated with endoscopic foreign body visualization and successful removal from the mouth. RESULTS Of the 168 endoscopies identified, the ingested item was visualized in 131 (78%) and was removed from the mouth in 88 (52.4%). 6.5% of cases required surgery and 2.4% of cases had a perforation noted. The two most common foreign bodies were food boluses (51.2%) and bones (28.6%). Older patients were more likely to have their ingested foreign body visualized during endoscopy (age ≥ 70 compared to 18-29 adjusted odds ratio [aOR] 8.78; 95% CI 1.62-47.70) and more likely to have it removed from the mouth (aOR 5.57; 95% CI 1.34-22.85). Bones were less likely to be visualized on endoscopy (aOR 0.16; 95% CI 0.04-0.57) but not less likely to be removed successfully (aOR 0.85; 95% CI 0.42-1.72). Foreign bodies visible on radiography were more likely to be identified on endoscopy (aOR 9.07; 95% CI 2.71-30.37) and more likely to be successfully removed (aOR 2.82; 95% CI 1.26-6.32). CONCLUSIONS Factors such as age, radiographic visibility, and the suspected foreign body may affect the likelihood that it can be visualized and removed. Future studies should focus on further characterizing complications of foreign body ingestions and the types of patients and objects most at risk.
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Affiliation(s)
- Jason Saltiel
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA.
| | - Rebecca Molinsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
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Rupert J, Honeycutt JD, Odom MR. Foreign Bodies in the Skin: Evaluation and Management. Am Fam Physician 2020; 101:740-747. [PMID: 32538598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Foreign bodies may be introduced into the skin through lacerations and soft tissue wounds. Long-term complications of retained foreign bodies include chronic pain and neurovascular impairment. Wound exploration and initial imaging with radiography or ultrasonography should be considered before foreign body removal. Risks and benefits of removal should be discussed with the patient. Although some foreign bodies may be left in place, removal should be considered if the risk of complications is high. A cooperative patient and adequate wound visualization are important for successful foreign body removal. Adequate analgesia and judicious use of anxiolytics and sedation may be helpful. Wound irrigation with normal saline or tap water is recommended after foreign body removal. Antiseptic solutions for wound irrigation may impair healing and should be avoided. Although there is no consensus on the use of antibiotic prophylaxis, several indications exist. The patient's tetanus immunization history should be reviewed, and vaccine should be administered if indicated.
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Affiliation(s)
- Jedda Rupert
- Mike O'Callaghan Military Medical Center, Nellis Air Force Base, NV, USA
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Abstract
Foreign body (FB) aspiration is a common and serious problem in childhood as it requires early recognition and treatment to avoid potentially lethal consequences. This study aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population.A retrospective review of medical records of children aged 0 to 14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between January 2013 and December 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs.Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years old. The male to female ratio was about 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal X-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. There was a trend that in children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was performed in 82.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during rigid bronchoscopy due to acute respiratory failure.FBs is a frequent pathology among Chinese children. Tracheobronchial FBs should be strongly suspected in young children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent.
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Affiliation(s)
- Guodong Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Beirong Wu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Angela Vinturache
- Department Obstetrics and Gynecology, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Chen Cai
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoxiang Gu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Shen MF, Liao WC, Chen CY. Bronchoscopic cryoextraction of an extracted tooth. QJM 2020; 113:292-293. [PMID: 31393576 DOI: 10.1093/qjmed/hcz209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M-F Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung, Taiwan
| | - W-C Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung, Taiwan
| | - C-Y Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung, Taiwan
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Krom H, Elshout G, Hellingman CA, Kindermann A, van Schuppen J, Tabbers MM. [Foreign body ingestion in children]. Ned Tijdschr Geneeskd 2019; 163:D4281. [PMID: 31750640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Foreign body ingestion occurs frequently in children and may lead to severe complications and mortality. In this article, three cases are presented. A 2-year-old boy swallowed a plastic toy helmet. He had no symptoms and physical examination was normal, and the toy was found in the stool within three days. Similarly, a 6-year-old girl swallowed two magnets and was asymptomatic. Physical examination was normal and a radiograph showed a foreign body which had passed the stomach. Due to the location, endoscopic removal by gastroduodenoscopy was not possible and surgical removal unnecessary. The magnets were secreted in the stool within two days. A 10-year-old boy with VACTERL association and psychiatric history, swallowed a button battery. After a delay in presentation, a radiograph showed a button battery mid-esophageal, which was endoscopically removed. He also needed dilatation due to esophageal stenosis. The above cases are all illustrative of the topic covered in the guideline 'Ingestion of foreign bodies in children aged 0-18 years', which was developed on behalf of the Dutch Pediatric Association and published in March 2019.
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Affiliation(s)
- Hilde Krom
- Emma Kinderziekenhuis, Amsterdam UMC, locatie AMC-UvA, Afd. Kinder-mdl, Amsterdam
- Contact: H. Krom
| | | | | | - Angelika Kindermann
- Emma Kinderziekenhuis, Amsterdam UMC, locatie AMC-UvA, Afd. Kinder-mdl, Amsterdam
| | - Joost van Schuppen
- Emma Kinderziekenhuis, Amsterdam UMC, locatie AMC-UvA, Afd. Radiologie en Nucleaire Geneeskunde, Amsterdam
| | - Merit M Tabbers
- Emma Kinderziekenhuis, Amsterdam UMC, locatie AMC-UvA, Afd. Kinder-mdl, Amsterdam
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49
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Lovrenski J, Vilotijević Dautović G, Lovrenski A. Reduced or Absent "Lung Sliding" - A Novel Lung Ultrasound Sign of Pediatric Foreign Body Aspiration. J Ultrasound Med 2019; 38:3079-3082. [PMID: 30892735 DOI: 10.1002/jum.14988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Jovan Lovrenski
- Radiology Department, Faculty of Medicine, University of Novi Sad, Institute for Children and Adolescents Health Care of Vojvodina, Novi Sad, Serbia
| | - Gordana Vilotijević Dautović
- Pulmonology Department, Faculty of Medicine, University of Novi Sad, Institute for Children and Adolescents Health Care of Vojvodina, Novi Sad, Serbia
| | - Aleksandra Lovrenski
- Pathology Department, Faculty of Medicine, University of Novi Sad, Institute for Pulmonary Diseases, Sremska Kamenica, Serbia
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Miró I, Ibáñez V, Carazo E, Couselo M, Vila JJ. [Applicability of a clinical score in patients with suspected foreign body aspiration]. Cir Pediatr 2019; 32:172-176. [PMID: 31626400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. MATERIAL AND METHODS Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. RESULTS Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. CONCLUSIONS The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.
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Affiliation(s)
- I Miró
- Hospital Universitario y Politécnico La Fe. Valencia
| | - V Ibáñez
- Hospital Universitario y Politécnico La Fe. Valencia
| | - E Carazo
- Hospital Universitario y Politécnico La Fe. Valencia
| | - M Couselo
- Hospital Universitario y Politécnico La Fe. Valencia
| | - J J Vila
- Hospital Universitario y Politécnico La Fe. Valencia
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