Airway Complications Resulting From Pediatric Esophageal Button Battery Impaction

Abstract

IMPORTANCE Button batteries (BBs) are commonly found in many household items and present a risk of severe injury to children if ingested. The direct apposition of the trachea and recurrent laryngeal nerves with the esophagus puts children at risk of airway injury secondary to the liquefactive necrotic effects of BB impactions.OBJECTIVE To review airway injuries, including long-term sequelae, after BB ingestion in children.EVIDENCE REVIEW For this systematic review, a comprehensive strategy was designed to search MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL (Cumulative Index of Nursing and Allied Health Literature) from inception to July 31, 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Additional cases were identified from the National Capital Poison Center BB registry. Individual authors were contacted for additional information. Studies with pediatric patients (<18 years) who developed airway injuries after BB ingestion were included. A total of 195 patients were included in the analysis; 95 were male. The mean (SD) age at BB ingestion was 17.8 (10.2) months. The mean (SD) time from BB ingestion to removal was 5.8 (9.0) days. The 2 most common airway sequelae observed in our series were 155 tracheoesophageal fistulae and 16 unilateral vocal cord paralyses. Twentythree children had bilateral vocal cord paralysis. The mean (SD) duration of ingestion leading to vocal cord paralysis was shorter than that of the general cohort (17.8 [22.5] hours vs 138.7 [216.7] hours, respectively). Children presenting with airway symptoms were likely to have a subsequent tracheoesophageal fistula or vocal cord paralysis.CONCLUSIONS AND RELEVANCE Airway injuries are a severe consequence of BB ingestion, occurring more often in younger children. This systematic review found that tracheoesophageal fistulae and vocal cord paralyses were the 2 most common airway injuries, often requiring tracheostomy. Vocal cord injury occurred after a shorter BB exposure time than other airway injuries. Continued efforts should be directed toward prevention strategies to avoid the devastating sequelae of BB-associated airway injury.

Pediatric Button Battery Injuries—Current State and What’s Next?

“…Philteos et al have clearly demonstrated the potential for airway injury from BB ingestion. Depending on the institution, esophageal BB cases may be primarily managed by otolaryngology, surgery, or gastroenterology services; a multidisciplinary team approach is important to ensure that a complete evaluation of the airway is performed.…”

“…Ultimately, a new BB technology that reduces or eliminates severe tissue injury when BBs are lodged in the esophagus is critically needed . When a safer BB technology exists, industry should act quickly to adopt it; severe airway injuries and fatalities among children as described by Philteos et al may one day become obsolete.…”

“…Ear Nose Throat J. 2015 The study by Philteos et al 1 in this issue of JAMA Otolaryngology-Head & Neck Surgery is a systematic review of published cases of airway injury among pediatric patients who ingested button batteries (BBs). Although these types of severe complications associated with BB ingestion have been previously reported, to date this is the largest review focused on airway injuries.…”

“…The use of injury mitigation strategies before or after BB removal was not assessed in this study, which is limited by the known underreporting of these cases to any data source. This review by Philteos et al describes complications from BB ingestions associated with airway injury, invaluably highlighting a significant source of pediatric morbidity and mortality …”

Pediatric Esophageal Foreign Bodies: The Role of Socioeconomic Status in Ingestion Patterns

“…Delayed diagnosis or recognition results in prolonged foreign body impaction time, which can lead to significant morbidity such as esophageal perforation, airway injury, and death. 1,[5][6][7] Identification of risk factors is a fundamental step in developing preventive strategies and decreasing morbidity and mortality in children.…”