Pradip P Kamat1,2, Matthew T Santore3, Nir Atlas4, Elizabeth M Sinclair5, Harold K Simon6, Erica L Riedesel7, Janet Figueroa8. 1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. Pradip.kamat@choa.org. 2. Children's Healthcare of Atlanta, 4th Floor PICU, 1405 Clifton Rd NE, Atlanta, GA, USA. Pradip.kamat@choa.org. 3. Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. 4. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. 5. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. 6. Division of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. 7. Division of Pediatric Radiology and Imaging, Department of Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30322, USA. 8. Department of Pediatrics, Pediatric Biostatistics Core at Emory University School of Medicine, Atlanta, GA, 30322, USA.
Abstract
PURPOSE: Institutions are adopting the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for pediatric esophageal button battery ingestion (EBBI). Our objective was to evaluate the guidelines' impact on in-hospital resource utilization and short-term clinical outcomes in hemodynamically stable patients after endoscopic battery removal. METHODS: A single-center retrospective review of all EBBI admissions from 2010 to 2020. Patients were divided into two groups based on adoption of national guidelines: pre-guideline (2010-2015) and post-guideline (2016-2020). RESULTS: Sixty-five patients were studied (pre-guideline n = 23; post-guideline n = 42). Compared with pre-guideline, post-guideline use of magnetic resonance imaging (MRI) increased (2/23 [8.7%]; 30/42 [71.4%]; p < 0.001). Post-guideline increases resulted for median days (IQR) receiving antibiotics (0 [0, 4]; 6 [3, 8]; p = 0.01), total pediatric intensive care unit admission (0 [0, 1]; 3 [0, 6]; p < 0.001), and total hospital length of stay (5 [2, 11]; 11.5 [4, 17]; p = 0.02). Two patients in the post-guideline group had delayed presentations despite normal imaging: one with TEF and one with aorto-esophageal fistula. All survived to discharge. CONCLUSION: In EBBI cases managed using the consensus based NASPHAGN guidelines, we report increased resource utilization without improved patient outcomes. Further research should evaluate post-guideline costs and resource utilization.
PURPOSE: Institutions are adopting the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines for pediatric esophageal button battery ingestion (EBBI). Our objective was to evaluate the guidelines' impact on in-hospital resource utilization and short-term clinical outcomes in hemodynamically stable patients after endoscopic battery removal. METHODS: A single-center retrospective review of all EBBI admissions from 2010 to 2020. Patients were divided into two groups based on adoption of national guidelines: pre-guideline (2010-2015) and post-guideline (2016-2020). RESULTS: Sixty-five patients were studied (pre-guideline n = 23; post-guideline n = 42). Compared with pre-guideline, post-guideline use of magnetic resonance imaging (MRI) increased (2/23 [8.7%]; 30/42 [71.4%]; p < 0.001). Post-guideline increases resulted for median days (IQR) receiving antibiotics (0 [0, 4]; 6 [3, 8]; p = 0.01), total pediatric intensive care unit admission (0 [0, 1]; 3 [0, 6]; p < 0.001), and total hospital length of stay (5 [2, 11]; 11.5 [4, 17]; p = 0.02). Two patients in the post-guideline group had delayed presentations despite normal imaging: one with TEF and one with aorto-esophageal fistula. All survived to discharge. CONCLUSION: In EBBI cases managed using the consensus based NASPHAGN guidelines, we report increased resource utilization without improved patient outcomes. Further research should evaluate post-guideline costs and resource utilization.
Authors: Pradip P Kamat; Carmen Sulton; Sapna R Kudchadkar; Courtney E McCracken; Khristopher M Nguyen; Stephen F Simoneaux; Michael D Mallory; Harold K Simon Journal: Acad Pediatr Date: 2019-03-08 Impact factor: 3.107
Authors: David E Brumbaugh; Steven B Colson; John A Sandoval; Frederick M Karrer; John F Bealer; Toby Litovitz; Robert E Kramer Journal: J Pediatr Gastroenterol Nutr Date: 2011-05 Impact factor: 2.839
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Authors: Erica L Riedesel; Edward J Richer; Elizabeth M Sinclair; Cary G Sauer; Matthew T Santore; Stephen F Simoneaux; Adina L Alazraki Journal: AJR Am J Roentgenol Date: 2020-09-22 Impact factor: 3.959
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