Richard Sola1, Eric H Rosenfeld2, Yangyang R Yu3, Shawn D St Peter4, Sohail R Shah5. 1. The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO, USA. Electronic address: rsola@cmh.edu. 2. Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA. Electronic address: ehrosenf@texaschildrens.org. 3. Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA. Electronic address: yxyangya@texaschildren.org. 4. The Center for Prospective Clinical Trials, The Children's Mercy Hospital, Kansas City, MO, USA. Electronic address: sspeter@cmh.edu. 5. Division of Pediatric Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA. Electronic address: sohailshahmd@gmail.com.
Abstract
PURPOSE: To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway. METHODS: Children <18years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed. RESULTS: From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0-12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 - Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2-67.8) as independent risk factors. CONCLUSION: Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion. LEVEL OF EVIDENCE: Level III.
PURPOSE: To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway. METHODS:Children <18years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed. RESULTS: From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0-12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 - Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2-67.8) as independent risk factors. CONCLUSION: Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion. LEVEL OF EVIDENCE: Level III.