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Jangan A, Watts E, Pankhania M. Coin-cidence? Have cashless payments reduced the incidence of upper aerodigestive foreign body insertion? A study of UK Hospital Episode Statistics. Ann R Coll Surg Engl 2024. [PMID: 38836371 DOI: 10.1308/rcsann.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES Insertions of nasal and oral foreign bodies (FB) are common presentations in the emergency department, with coins frequently implicated among paediatric populations. Contactless payments were first introduced in the UK in 2007, and cash payments significantly declined from 2012. This study aims to explore the potential implications of increasing contactless payments on FB ingestion. METHODS UK Hospital Episode Statistics (HES) were reviewed between 2000 and 2022. All FB retrieval procedures involving the alimentary tract, respiratory tract and nasal cavity were included. Regression analysis was performed to assess trends in the incidence of FB ingestion before and following the transition to cashless payments in 2012. RESULTS Following the decline in cash payments in 2012, the frequency of alimentary tract FB removal procedures decreased significantly by 27.78 procedures per year (p < 0.001). Similarly, respiratory FB removal procedure decreased by 4.83 per year (p = 0.009) and nasal cavity FB removal procedures decreased by 52.82 per year (p < 0.001). CONCLUSIONS This study suggests a statistically significant decline in the number of procedures for removal of FB performed in the UK from 2012. Although this relationship is multifactorial, our data suggest an association between the introduction of contactless payments and a reduction in the number of FB retrieval procedures from the of upper aerodigestive tract.
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Affiliation(s)
- A Jangan
- Walsall Healthcare NHS Trust, UK
| | - E Watts
- University Hospitals Birmingham NHS Foundation Trust, UK
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2
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Ocagli H, Azzolina D, Francavilla A, Aydin E, Baldas S, Cocciaglia A, Rodriguez H, Gregori D, Lorenzoni G, Gruber M. Management of Pediatric Foreign Body Injuries during the COVID-19 Pandemic: Results of an International Survey. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1845. [PMID: 38136047 PMCID: PMC10741619 DOI: 10.3390/children10121845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
The COVID-19 pandemic has had direct and indirect effects on daily life. In hospitals, the impact of the pandemic was observed in the diagnostic and therapeutic workflow. In this work, we explored potential changes in activities related to the treatment of foreign body injuries (FBIs) in children and the behavioral habits of physicians during the first wave of the pandemic. An online survey was conducted among physicians of the Susy Safe network. The survey comprised items related to respondent information, reference center characteristics, the treatment of FBIs during the COVID-19 pandemic, and a modified COVID-19 Anxiety Scale (CAS). The survey was distributed among the Susy Safe project international network surveillance registry for FBIs. A total of 58 physicians responded to the survey, including 18 (32%) from Europe and 16 (28%) from South America. The respondents indicated that the estimated number of aspirated foreign bodies during the pandemic was lower than or the same as that before the pandemic (43, 74%), and the same was observed for ingested foreign bodies (43, 74%). In univariable logistic regression, no single predictor was associated with a delay in routine care for children or an increasing tendency of medical personnel to avoid procedures. The workflow of physicians involved in the management of FBIs in children has not changed drastically during the COVID-19 pandemic, especially in emergency departments.
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Affiliation(s)
- Honoria Ocagli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padova, Italy; (H.O.); (D.A.); (A.F.); (G.L.)
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padova, Italy; (H.O.); (D.A.); (A.F.); (G.L.)
- Department of Medical Science, University of Ferrara, 44121 Ferrara, Italy
| | - Andrea Francavilla
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padova, Italy; (H.O.); (D.A.); (A.F.); (G.L.)
| | - Emrah Aydin
- Department of Pediatric Surgery, School of Medicine, Koç University, 34450 Istanbul, Turkey;
| | - Solidea Baldas
- Protecting Children Association (Prochild) Onlus, 34129 Trieste, Italy;
| | | | - Hugo Rodriguez
- Hospital de Pediatría Juan P. Garrahan, Buenos Aires C1245, Argentina;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padova, Italy; (H.O.); (D.A.); (A.F.); (G.L.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padova, Italy; (H.O.); (D.A.); (A.F.); (G.L.)
| | - Maayan Gruber
- Galilee Medical Center, Azrieli faculty of Medicine, Bar-Ilan University, Haifa 22100, Israel;
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3
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Munhall CC, Shah S, Nguyen SA, Meyer TA, Schlosser RJ, White DR. Otolaryngologic Presentations to Emergency Departments During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2023; 132:1467-1476. [PMID: 37016555 PMCID: PMC10076161 DOI: 10.1177/00034894231165575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To perform a systematic review of otolaryngologic presentation rates to emergency department settings before and after lockdown due to the COVID-19 pandemic. SOURCES PubMed, Scopus, and CINAHL. METHODS A systematic search was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing otolaryngologic presentations to emergency department and rapid access clinic settings both in the before-lockdown and after-lockdown periods. The start of after-lockdown period varied based on initiation of lockdown, ranging from March 1st to June 1st of 2020 across general emergency department studies. RESULTS A total of 14 studies were included in this review. About 10 were general emergency departments, 3 were specifically pediatric emergency departments, and 1 study focused on the geriatric population (>65 years). A total of 13 790 patients were included, with 9446 in the before-lockdown period (68.5%) and 4344 in the after-lockdown period (31.5%). Meta-analysis of proportions for otolaryngologic presentations across general emergency departments was performed. Comparison of weighted proportions found significant differences between before-lockdown and after-lockdown presentation rates for infectious etiologies, tonsillitis specifically, foreign bodies, non-infectious airway issues, and epistaxis among these studies. CONCLUSIONS The increased proportions of various non-infectious presentations (eg, epistaxis, foreign bodies, and airway issues) following lockdown might be associated with proportional decreases in infectious pathologies, given decreased social contact to prevent SARS-CoV-2 transmission. Overall, it is important for otolaryngologists to recognize what presentations might more commonly be seen and require evaluation and potential intervention in light of a global pandemic.
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Affiliation(s)
- Christopher C. Munhall
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Sunny Shah
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Ted A. Meyer
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J. Schlosser
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - David R. White
- Department of Otolaryngology – Head and
Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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4
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Hong SJ, Kim C, Lee DW, Jang HJ, Cho SM, Choi KH, Hwang JH, Choe JY. Foreign body ingestion trends in children in the Daegu-Kyungpook Province, Korea before and during the COVID-19 period: a repeated cross-sectional study. Transl Pediatr 2023; 12:1364-1372. [PMID: 37575898 PMCID: PMC10416120 DOI: 10.21037/tp-23-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) period, children spent more time at home, which is where most foreign body ingestions (FBIs) in children occur. We compared the rate of FBI in children in the Daegu-Kyungpook Province during COVID-19 to the rate in the 2 years before the COVID-19 period. Methods The period from January to December in the year 2020 was defined as the COVID-19 period, and the corresponding time period in 2018 and 2019 was defined as the pre-COVID-19 period. Medical records were analyzed retrospectively for pediatric patients aged 0-15 years who visited outpatient and emergency rooms at seven tertiary referral hospitals in Daegu-Kyungpook Province. Results The annual occurrence rate of FBIs in patients visiting seven tertiary referral hospitals was not different during COVID-19 compared to that in the pre-COVID-19 period and the median age of these patients during the COVID-19 and pre-COVID-19 periods was similar. However, occurrence rates increased in the groups aged 0-3 and 4-6 years but decreased in the group aged 7-15 years during the COVID-19 period. The proportion of male patients as well as inpatients increased significantly during the COVID-19 period (both P=0.01). The proportion of foreign bodies located in the post-pyloric region increased during the COVID-19 period (P=0.02). The most common symptom, foreign body sensation in the neck, was similar in both groups. There was no significant difference in the foreign body removal method between the two groups. The occurrence rates of swallowing of toys, coins, magnets, button batteries, and superabsorbent polymers non-significantly increased; and the food ingestion rate decreased, while the non-food ingestion rate increased in all age groups during the COVID-19 period. Conclusions The FBI rate in children did not differ during the COVID-19 period compared to that in the pre-COVID-19 period. The occurrence of FBI in boys, the number of foreign bodies located in the post-pyloric region, and the number of hospitalizations due to FBI increased during the COVID-19 period.
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Affiliation(s)
- Suk Jin Hong
- Department of Pediatrics, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Changho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Won Lee
- Department of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
| | - Hyo Jeong Jang
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Seung Man Cho
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Kwang Hae Choi
- Department of Pediatrics, Yeungnam University School of Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Jun Hyun Hwang
- Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jae Young Choe
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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5
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Nugud AA, Tzivinikos C, Assa A, Borrelli O, Broekaert I, Martin-de-Carpi J, Deganello Saccomani M, Dolinsek J, Homan M, Mas E, Miele E, Thomson M, Benninga MA. Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper. J Pediatr Gastroenterol Nutr 2023; 76:523-532. [PMID: 36947000 DOI: 10.1097/mpg.0000000000003702] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management.
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Affiliation(s)
- A A Nugud
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Christos Tzivinikos
- From the Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Amit Assa
- The Juliet Keidan Institute of Pediatric Gastroenterology, Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Osvaldo Borrelli
- the Division of Neurogastroenterology & Motility, Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Ilse Broekaert
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | - Jernej Dolinsek
- the Department of Pediatrics, University Medical Center Maribor, Maribor, Slovenia
| | - M Homan
- the Faculty of Medicine, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Emmanuel Mas
- Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, and IRSD, Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France
| | - Erasmo Miele
- the Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Mike Thomson
- the Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc A Benninga
- the Department of Paediatrics, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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6
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Tan Q, Wang T, Xu N, Zhang G, Luo X. Characteristics of unintentional childhood injury during COVID-19: a single-center comparative study. Transl Pediatr 2023; 12:405-416. [PMID: 37035401 PMCID: PMC10080488 DOI: 10.21037/tp-23-79] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023] Open
Abstract
Background There are many articles related to child injuries during the coronavirus disease of 2019 (COVID-19) in other countries, but only few studies in this field in China. This study analyzes the clinical characteristics of unintentional childhood injury during the pandemic, to provide reference for the prevention of unintentional childhood injury in the context of pandemic. Methods A comparative study was performed on the medical data of 2,497 children with unintentional injury who were hospitalized at Chengdu Women's and Children's Central Hospital between 1 January, 2018 and 31 May, 2021. The study period was divided into 2 periods, before the pandemic (1 January, 2018 to 31 May, 2019), during the pandemic (1 January, 2020 to 31 May, 2021). The number of unintentional childhood injuries and age distribution before and during the pandemic were compared. Group differences were examined using Mann-Whitney U for continuous variables and Chi-squared or Kruskal-Wallis tests for categorical variables. Results There were significant differences in age, accident location, hospitalization days, and medical expenses before and during the pandemic (P<0.05). During the pandemic, the number of children's unintentional injuries increased by 34.24% (1,066 vs. 1,431, P=0.000), and the significantly increased types of unintentional injuries included foreign bodies, falls, crush injuries, and sharp injuries. During the pandemic, the highest proportion of unintentional injury to children was foreign bodies, whereas the proportion of falls was the highest before the pandemic. During the pandemic, the number of foreign body injuries in toddler was significantly higher than before the pandemic (P=0.001), but the number of falls, crush injuries, and sharp injuries in preschooler was significantly higher (P<0.05). Conclusions In the circumstance of the COVID-19, the number of foreign bodies, falls, crush injuries, and sharp injuries, in children increased significantly. It is necessary to strengthen the prevention of foreign bodies in toddler, and falls, crush injuries, and sharp injuries in preschooler.
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Affiliation(s)
| | | | - Nuo Xu
- Department of Pediatric Critical Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guoying Zhang
- Department of Pediatric Critical Medicine, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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7
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Kiefer A, Duppel U, Schützenmeier A, Lang T, Kittel J, Kabesch M, Kerzel S. Button Battery Ingestions cause the Majority of Severe Complications. KLINISCHE PADIATRIE 2023; 235:90-97. [PMID: 36758576 DOI: 10.1055/a-2007-1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Foreign body ingestion in children is a clinically important reason for presentation to the emergency department. The individual outcome ranges from benign spontaneous courses to severe complications. Fatal outcomes occur rarely and complications are related to patient's age as well as type and location of the foreign body. The aim of our present study was to evaluate the outcome of children and adolescents with foreign body ingestion with a focus on complications, which mainly occurred after button battery ingestion. METHODS We reviewed medical records of patients between 0 and 18 years of age who had presented to the paediatric emergency department of our hospital with suspected foreign body ingestion between January 2011 and March 2021 (123 months). Clinical, imaging, and endoscopic data as well as treatment modalities were analysed. RESULTS In the ten10 year period under review, a total of 1,162 children and adolescents (6 months - 18 years) presented to our emergency room with suspected foreign body ingestion. Among those, 398 ingestions (34%) could be verified radiologically and/or endoscopically, while in the remaining 764 cases (66%) the suspicion could not be confirmed. The majority of patients with verified ingestion (n=324; 81%) presented with ingestion of a metallic foreign body. We observed 55 cases with verified ingestion of a button battery. Five of these cases had severe complications, with a near-fatal course in two patients who developed an oesophageal-tracheal fistula. CONCLUSION In contrast to all other ingestions of foreign bodies in children, button battery ingestions lead to mucosal damage and severe complications in a significant number of children.
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Affiliation(s)
- Alexander Kiefer
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Uta Duppel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Alexander Schützenmeier
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Thomas Lang
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Jochen Kittel
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Sebastian Kerzel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
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8
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Golan-Tripto I, Tsabari R, Picard E, Stafler P, Armoni Domany K, Goldbart AD, Aviram M, Gatt D, Bari R, Tsaregorodtsev S, Peled C, Melnik P, Bar-Yoseph R, Gut G. Foreign body aspiration in Israeli children during the COVID-19 pandemic. Pediatr Pulmonol 2023; 58:425-432. [PMID: 36224102 DOI: 10.1002/ppul.26203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19 pandemic, in comparison to the prior years. METHODS In this retrospective multicenter study, we compared the number of children who presented with FBA during the COVID-19 year (March 1, 2020 to February 28, 2021) to the annual average of the years 2016-2019. We also compared the lockdown periods to the postlockdown periods, and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. RESULTS A total of 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior 4 years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in postlockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (average of 15.4% vs. 30.4%, p = 0.001). CONCLUSION There were fewer cases of pediatric FBA during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision, with no difference in the prevalence of FBA during the COVID-19 year.
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Affiliation(s)
- Inbal Golan-Tripto
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reuven Tsabari
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Pediatric Pulmonology Unit and Cystic Fibrosis Center, Pediatric Department, Hadassah Medical Center, Jerusalem, Israel
| | - Elie Picard
- Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Aviv D Goldbart
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvir Gatt
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Romi Bari
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesia and Critical care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Chilaf Peled
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Pesah Melnik
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel
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9
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Neal JT, Monuteaux MC, Porter JJ, Hudgins JD. The Effect of COVID-19 Stay-At-Home Orders on the Rate of Pediatric Foreign Body Ingestions. J Emerg Med 2022; 63:729-737. [PMID: 36289021 PMCID: PMC9472683 DOI: 10.1016/j.jemermed.2022.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/19/2022] [Accepted: 09/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Foreign body ingestions are a common presentation in the emergency department (ED), particularly in young children. OBJECTIVE We sought to determine whether the COVID-19 pandemic lockdowns had an effect on the proportion of foreign body ingestions. METHODS We performed a retrospective review of the Pediatric Health Information System for patients younger than 19 years who were identified by International Classification of Diseases, Tenth Revision codes for foreign body ingestion. We analyzed patients in the following three groups: young children (younger than 5 years), school-aged children (5-12 years), and adolescents (13 years and older), using an interrupted time series analysis. Our primary outcome was the difference in proportion of foreign body ingestions. We compared 1 year after the declaration of the COVID-19 pandemic (March 13, 2020 to March 31, 2021) with the previous 3 years (March 1, 2017 to March 12, 2020). RESULTS Total pediatric ED encounters decreased in the post period (p < 0.01); 4902 patients per year presented for foreign body ingestion pre-COVID-19 shutdown vs. 5235 patients per year post-COVID-19 shutdown. In all three age groups (young children, school-age children, and adolescents), there was a higher proportion of foreign body ingestions post-COVID-19 shutdown (p < 0.01, p < 0.01, and p = 0.028, respectively), driven primarily by the decrease in total ED encounters. In the youngest age group (younger than 5 years), there was also a significant increase in slope for foreign body ingestions post-COVID-19 (p = 0.010). CONCLUSIONS The proportion of foreign body ingestions increased after the declaration of the COVID-19 pandemic, primarily driven by an overall decrease in total ED volume.
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Affiliation(s)
- Jeffrey T. Neal
- Reprint Address: Jeffrey T. Neal, MD, Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
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10
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Abstract
OBJECTIVES To review the clinical management and outcomes of magnet ingestions at a large tertiary children's hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets. METHODS Children <18 years who presented to the emergency room and were admitted to the Children's Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) pre-ban (2008-2012), (2) intra-ban (2013-2016), and (3) post-ban (2017-2020). RESULTS There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3-9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms ( P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) ( P < 0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period ( P = 0.021). CONCLUSIONS Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.
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Geibel E, Pasman E, Nylund C, Rudolph B, Reeves P. The Impact of the COVID-19 Pandemic on Foreign Body Ingestion Trends in Children: A Comparison of the Pre-Pandemic Period to 2020. J Pediatr Gastroenterol Nutr 2022; 75:299-303. [PMID: 35984456 PMCID: PMC9365073 DOI: 10.1097/mpg.0000000000003472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/30/2022] [Indexed: 12/10/2022]
Abstract
Foreign body ingestion (FBI) among children is associated with morbidity and mortality. We used the National Electronic Injury Surveillance System to compare FBI trends from 2017-2019 to 2020 during the spread of SARS-CoV-2. The pandemic and associated stay-at-home orders were associated with uptrends in button battery and magnet ingestions but unchanged total FBI trends.
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Affiliation(s)
- Elyse Geibel
- From the Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA, USA
| | - Eric Pasman
- From the Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA, USA
- the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cade Nylund
- the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Bryan Rudolph
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA, and the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Brooke Army Medical Center, San Antonio, TX, USA
| | - Patrick Reeves
- the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- the Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Wolter NE, Wolter JK, James AL, Ostrow O, McKinnon NK, Everett T, Papsin BC, Propst EJ. Button battery taping prevents oesophageal injury. J Paediatr Child Health 2022; 58:1337-1344. [PMID: 35445484 DOI: 10.1111/jpc.15978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 01/23/2023]
Abstract
AIM Most button battery (BB) ingestions in children are unwitnessed leading to prolonged exposures and severe complications. One third of ingestions occur from free BB, that are stored or awaiting disposal. Recommendations have been made to cover the terminals of discarded BB with adhesive tape; however, it is unclear if this practice prevents injury. Our aim was to determine if tape could prevent oesophageal injury in a cadaveric porcine model. METHODS Electrical, masking, packing and duct tape were compared. One BB was left untaped. Taped BBs were placed in a cadaveric porcine oesophagus controlled for temperature and humidification. Specimens were assessed at 0, 0.5, and hourly for 6 h by visual inspection, temperature and pH. BB voltage was measured before and after testing. All tests were repeated in triplicate. RESULTS Oesophageal specimens demonstrated burn prevention in the packing and duct tape trials. Burns were seen in 2/3 trials with electrical tape and 3/3 trials with masking tape. pH remained neutral throughout the study for all packing and duct tape specimens. pH remained neutral initially for masking tape but increased rapidly to 12 by 2 h. There was no change in battery voltage for the packing tape and duct tape trials. There was a 16.3% reduction in voltage for masking tape which was similar to controls. CONCLUSIONS Taping BB with packing tape and duct tape prevented oesophageal burns. This may provide a novel method of burn prevention for loose BB intended for disposal.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer K Wolter
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nicole K McKinnon
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tobias Everett
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Poupore NS, Shih MC, Nguyen SA, Brennan EA, Clemmens CS, Pecha PP, McDuffie LA, Carroll WW. Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review. Int J Pediatr Otorhinolaryngol 2022; 157:111100. [PMID: 35523610 DOI: 10.1016/j.ijporl.2022.111100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION During the SARS-CoV-2 pandemic, the incidence of pediatric button battery (BB) ingestions has risen. Children have spent more time at home from school, while many parents try to balance working from home and childcare. Additionally, the amount of electronics powered by BB has increased. Tracheoesophageal fistula (TEF) secondary to a retained aerodigestive BB is a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for TEF is poorly defined in the literature. METHODS In accordance with PRISMA guidelines, databases searched include PubMed, Scopus, and CINAHL from database date of inception through August 13, 2021. All study designs were included, and no language, publication date, or other restrictions were applied. Case series and reports of TEFs secondary to BBs were included. Clinical risk factors and outcomes were compared between the spontaneous closure and surgical repair groups. RESULTS A total of 79 studies with 105 total patients were included. Mortality was 11.4%. There were 23 (21.9%) TEFs that spontaneously closed and 71 (67.6%) that underwent surgical repair. Median time to spontaneous closure compared to surgical repair was significantly different (8.0 weeks [IQR 4.0-18.4] vs. 2.0 weeks [IQR 0.1-3.3], p<0.001). Smaller TEFs were more likely to spontaneously close versus being surgically repaired (9.3 mm ± 3.5 vs. 14.9 mm ± 8.3, p=0.022). Duration of symptoms before BB discovery, BB size, time between BB removal and TEF discovery, and location of the TEF were not statistically different between the spontaneous closure and surgical repair groups. CONCLUSION A TEF secondary to BB ingestion is a potentially deadly complication. Timing of reported TEF spontaneous closure varies significantly. While smaller TEFs may be amenable to healing without surgical repair, no other significant factors were identified that may be associated with spontaneous closure. If clinical status permits, these data suggest a period of observation of at least 8 weeks prior to surgical intervention may be practical for many BB-induced TEFs.
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Affiliation(s)
- Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Michael C Shih
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Emily A Brennan
- Medical University of South Carolina, Department of Research and Education Services, Medical University of South Carolina Libraries, 171 Ashley Avenue, Charleston, SC, 29425, USA
| | - Clarice S Clemmens
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Lucas A McDuffie
- Medical University of South Carolina, Department of Surgery, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
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