Evaluation of a Symptom-Based Algorithm for Managing Battery Ingestions in Children

Abstract

Objectives While complications from battery ingestion can be severe, especially with the emergence of stronger battery elements, not all ingestions require prompt removal. We aim to evaluate a symptom-focused algorithm for battery ingestion that emphasizes observation over intervention to investigate its safety.

Materials and Methods Patients were identified through a query of foreign-body ingestion radiographs obtained between 2017 and 2020. A retrospective chart review was then performed of all patients who presented with button battery ingestions to identify compliance with our algorithm, overall outcomes, and complications.

Results In total, 2% of all radiographs (44/2,237) demonstrated button battery ingestions. The median age of patients was 3.8 years (interquartile range, 2.6–5.3). Most batteries were found in the stomach (64%, n = 28), but were also identified in the esophagus (14%, n = 6), small bowel (14%, n = 6), and colon (9%, n = 4). All esophageal batteries were managed with immediate endoscopic retrieval. Ten gastric batteries were not managed per protocol, with seven admitted for observation despite being asymptomatic and repeat abdominal X-rays demonstrating persistent gastric location of the battery. Four patients underwent esophagogastroduodenoscopy; however, in two patients the battery had migrated past the stomach prior to intervention. All small bowel batteries and three of four asymptomatic colon batteries were managed per protocol; one patient had additional imaging that demonstrated battery passage.

Conclusion Adherence to a symptom-focused protocol for conservative management of button battery ingestions beyond the gastroesophageal junction is safe and frequently does not require admission, serial imaging, or intervention.

Keywords

button battery - foreign body ingestion - battery ingestion

Publication History

Received: 30 June 2021

Accepted: 21 October 2021

Article published online:
16 December 2021

• References

• 1 Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics 2010; 125 (06) 1168-1177
• 2 Eliason MJ, Melzer JM, Winters JR, Gallagher TQ. Identifying predictive factors for long-term complications following button battery impactions: a case series and literature review. Int J Pediatr Otorhinolaryngol 2016; 87: 198-202
• 3 Poison Control. Button battery ingestion statistics. Battery Statistics from National Poison Data System (NPDS) and National Battery Ingestion Hotline (NBIH). 2020. Available at: https://www.poison.org/battery/stats#20161
• 4 The Children's Hospital of Philadelphia. Foreign body ingestion clinical pathway - emergency department, ICU, and inpatient. August 12, 2014. Available at: https://www.chop.edu/clinical-pathway/foreign-body-ingestion-clinical-pathway
• 5 Children's Hospital Colorado. Clinical pathways - ingested button batteries. May 19, 2020. Available at: https://www.childrenscolorado.org/health-professionals/clinical-resources/clinical-pathways/
• 6 Kramer RE, Lerner DG, Lin T. et al; North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Endoscopy Committee. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60 (04) 562-574
• 7 Mubarak A, Benninga MA, Broekaert I. et al. Diagnosis, management, and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper. J Pediatr Gastroenterol Nutr 2021; 73 (01) 129-136
• 8 Krom H, Visser M, Hulst JM. et al. Serious complications after button battery ingestion in children. Eur J Pediatr 2018; 177 (07) 1063-1070
• 9 Ríos G, Rodríguez L, Lucero Y, Miquel I, Arancibia ME, Alliende F. Endoscopic findings associated with button battery ingestion in children: do we need to change the protocol for managing gastric location?. Pediatr Emerg Care 2020; 36 (11) 523-526
• 10 Khalaf RT, Ruan W, Orkin S. et al. Gastric injury secondary to button battery ingestions: a retrospective multicenter review. Gastrointest Endosc 2020; 92 (02) 276-283
• 11 Rosenfeld EH, Sola Jr R, Yu Y, St Peter SD, Shah SR. Battery ingestions in children: variations in care and development of a clinical algorithm. J Pediatr Surg 2018; 53 (08) 1537-1541
• 12 Soto PH, Reid NE, Litovitz TL. Time to perforation for button batteries lodged in the esophagus. Am J Emerg Med 2019; 37 (05) 805-809
• 13 Pugmire BS, Lin TK, Pentiuk S, de Alarcon A, Hart CK, Trout AT. Imaging button battery ingestions and insertions in children: a 15-year single-center review. Pediatr Radiol 2017; 47 (02) 178-185
• 14 Lee JH, Lee JH, Shim JO, Lee JH, Eun BL, Yoo KH. Foreign body ingestion in children: should button batteries in the stomach be urgently removed?. Pediatr Gastroenterol Hepatol Nutr 2016; 19 (01) 20-28
• 15 Al Lawati TT, Al Marhoobi RM. Timing of button battery removal from the upper gastrointestinal system in children. Pediatr Emerg Care 2021; 37 (08) e461-e463
• 16 Litovitz TL. Battery ingestions: product accessibility and clinical course. Pediatrics 1985; 75 (03) 469-476
• 17 Leinwand K, Brumbaugh DE, Kramer RE. Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions. Gastrointest Endosc Clin N Am 2016; 26 (01) 99-118
• 18 Shaffer AD, Jacobs IN, Derkay CS. et al. Management and outcomes of button batteries in the aerodigestive tract: a multi-institutional study. Laryngoscope 2021; 131 (01) E298-E306