Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada.
Laryngoscope. 2024 Dec;134(12):5170-5177. doi: 10.1002/lary.31607. Epub 2024 Jun 27.
Evaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies.
We developed a protocol for esophageal BB management [Zakai's Protocol (ZP)]. All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated.
Fifty-one patients (38 pre-ZP, 13 post-ZP) were included. Median age was 2.3 years (IQR 1.3-3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h [4.6 h (IQR 3.9-6.5) to 0.4 h (IQR 0.3-0.6), p < 0.001] and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x-ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%.
Implementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications.
3, Case-series Laryngoscope, 134:5170-5177, 2024.
评估实施机构方案以减少食管纽扣电池（BB）取出时间并增加缓解策略的使用。
我们制定了食管 BB 管理的方案[Zakai 方案（ZP）]。回顾了 2011 年至 2023 年在一家三级护理中心管理的所有食管 BB 嵌顿病例，包括实施前后的病例。评估 BB 取出时间、关键步骤的依从性以及缓解策略（蜂蜜/硫糖铝、醋酸）的使用情况。
共纳入 51 例患者（ZP 前 38 例，ZP 后 13 例）。中位年龄为 2.3 岁（IQR 1.3-3.4）。实施后，从到达机构到进入手术室（OR）的时间缩短了 4.2 小时[4.6 小时（IQR 3.9-6.5）至 0.4 小时（IQR 0.3-0.6），p<0.001]，并且所有管理步骤都有所改善。直接转诊耳鼻喉科的患者数量从 51%增加到 92%，到达通知率从 86%增加到 100%，避免第二次 X 射线检查从 63%增加到 100%，直接转至 OR 的比例从 92%增加到 100%。术前给予蜂蜜或硫糖铝等缓解策略的依从性从 0%增加到 38%，术中使用醋酸的比例从 3%增加到 77%，鼻胃管插入的比例从 53%增加到 92%。
在我们的三级护理机构中，实施 ZP 显著缩短了 BB 取出时间和缓解策略的使用。需要进一步采取预防 BB 摄入和缩短转移到三级护理医院的时间的策略，以防止腐蚀性并发症的发生。
3，病例系列研究，喉镜，134：5170-5177，2024。
