From the Pediatric Gastroenterology.
Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Department of Pediatrics.
Pediatr Emerg Care. 2023 Apr 1;39(4):259-264. doi: 10.1097/PEC.0000000000002690. Epub 2022 Mar 30.
The aims of this study were to characterize the patient population and initial presentation and care of esophageal button battery ingestion and provide descriptive data including factors affecting accurate diagnosis, duration of battery exposure, and battery removal.
This was a retrospective cohort study from 2007 to 2020 at a single-center, large-volume, urban academic pediatric hospital system. Included participants were children 6 months to 18 years old who underwent removal of an esophageal button battery impaction at our institution.
Our cohort comprised 63 patients; ages ranged from 7 to 87 months with a median of 27 months. Median button battery size was 2.12 cm with 59% lodged in the proximal esophagus. A prolonged impaction, greater than 12 hours, occurred in 46% of patients. Risk ratio analysis demonstrated that lack of caregiver suspicion of ingestion was associated with prolonged impaction (risk ratio, 3.39; confidence interval, 2.15-5.34). Misdiagnosis of button battery ingestion occurred in 10% of cases. The majority of patients, 87%, required transfer from a referring facility with a median total distance of 37 miles (range, 1.4-160 miles) from home to facility where battery was removed.
This study describes the initial presentation and care of a large cohort of pediatric esophageal button battery ingestion. It emphasizes the continued need for primary prevention, prompt identification, and removal of these batteries. There are many challenges in caring for these patients involving multiple pediatric disciplines, and guidelines encompassing a multidisciplinary approach would be beneficial.
本研究旨在描述食管纽扣电池吞食患者的人群特征、初始表现和治疗情况，并提供包括影响准确诊断的因素、电池暴露时间以及电池取出时间等描述性数据。
这是一项 2007 年至 2020 年在单中心、大容量、城市学术儿科医院系统进行的回顾性队列研究。纳入研究对象为在我院接受食管纽扣电池嵌顿取出术的 6 个月至 18 岁儿童。
本队列纳入 63 例患者，年龄 7 至 87 个月，中位数为 27 个月。纽扣电池中位大小为 2.12cm，59%位于食管近端。46%的患者纽扣电池嵌顿时间超过 12 小时。风险比分析表明，看护者对吞食的怀疑不足与嵌顿时间延长有关（风险比，3.39；置信区间，2.15-5.34）。纽扣电池吞食的误诊发生率为 10%。87%的患者需要从转诊机构转至治疗机构，转诊中位总距离为 37 英里（范围，1.4-160 英里）。
本研究描述了一大组儿科食管纽扣电池吞食患者的初始表现和治疗情况。研究强调了纽扣电池的持续一级预防、及时识别和取出的重要性。此类患者的治疗涉及多个儿科专科，存在许多挑战，制定涵盖多学科方法的指南将是有益的。
