Elizabeth M Sinclair1, Matthew T Santore2, Maneesha Agarwal3, Jamie Kitzman4, Cary G Sauer1, Erica L Riedesel5. 1. Pediatric Gastroenterology, Department of Pediatrics. 2. Pediatric Surgery, Department of Surgery and Pediatrics. 3. Pediatric Emergency Medicine, Department of Pediatrics. 4. Pediatric Anesthesiology, Department of Anesthesiology and Pediatrics. 5. Pediatric Radiology, Department of Radiology and Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
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.
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.
Authors: Diana G Lerner; David Brumbaugh; Jenifer R Lightdale; Kris R Jatana; Ian N Jacobs; Petar Mamula Journal: J Pediatr Gastroenterol Nutr Date: 2020-05 Impact factor: 2.839
Authors: Maureen E Clark; Brian M Cummings; Karen Kuhlthau; Natalie Frassica; Natan Noviski Journal: J Intensive Care Med Date: 2017-08-11 Impact factor: 3.510
Authors: Elizabeth M Sinclair; James P Stevens; Barbara McElhanon; Jonathan A Meisel; Matthew T Santore; A Alfred Chahine; Erica L Riedesel Journal: J Pediatr Surg Case Rep Date: 2021-01-07