High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study

Middelberg, Leah K.; Leonard, Julie C.; Shi, Junxin; Aranda, Arturo; Brown, Julie C.; Cochran, Christina; Eastep, Kasi; González, Raquel; Haasz, Maya; Herskovitz, Scott; Hoffmann, Jennifer A.; Koral, Alexander; Lamoshi, Abdulraouf; Levitte, Steven; Lo, Yu Hsiang; Montminy, Taylor; Novak, Inna; Ng, Kenneth W.; Novotny, Nathan M.; Parrado, Raphael H.; Ruan, Wenly; Shapiro, Joseph I.; Sinclair, Elizabeth M.; Stewart, Amanda M.; Talathi, Saurabh; Tavarez, Melissa M.; Townsend, Peter; Zaytsev, Julia; Rudolph, Bryan

doi:10.1542/peds.2021-054543

Cited by 20 publications

(28 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There was significant morbidity in these patients, including hospitalizations (68%), endoscopic or surgical procedures (72%), and severe outcomes (12%). Our experience was consistent with other single-center studies in Taiwan and Canada (10,13) and multicenter studies in the United States and China describing the management of magnet ingestions (3,11,14). In these studies, a high percentage of patients with magnet ingestion required surgical or endoscopic procedures for removal (range 46%–81%), and there was a high rate of severe outcomes including perforation, fistula formation, obstruction, infection, and bleeding (range 10%–39%).…”

Section: Discussionsupporting

confidence: 90%

“…There were no deaths in our cohort. Patients who required surgical interventions required a longer hospital stay compared to nonsurgical patients with a median of 5 days (IQR, [3][4][5][6][7][8][9][10][11].…”

Section: Multiple Magnet Ingestionmentioning

confidence: 99%

“…Studies are emerging showing increased calls to poison control centers, and increased ED visits since the magnet ban was overturned (3,9,10). Additionally, a recent multicenter retrospective study reviewed the breadth of clinical outcomes, morbidity, and common management techniques for magnet ingestions over a 2-year period (11). We sought to further contribute to the literature by conducting a retrospective cohort study at a large, urban tertiary care children's hospital over a more extended time period.…”

Section: What Is Newmentioning

confidence: 99%

See 2 more Smart Citations

Management of Magnet Ingestions at a Large Tertiary Care Children’s Hospital

Shaul

Agawu

Wood

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

View full text Add to dashboard Cite

Objectives: To review the clinical management and outcomes of magnet ingestions at a large tertiary children's hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets. Methods: Children <18 years who presented to the emergency room and were admitted to the Children's Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) preban (2008)(2009)(2010)(2011)(2012), (2) intra-ban (2013-2016), and (3) post-ban (2017-2020). Results: There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3-9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms (P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) (P < 0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period (P = 0.021). Conclusions:Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Multiple Magnet Ingestionmentioning

confidence: 99%

Section: What Is Newmentioning

confidence: 99%

See 1 more Smart Citation

Management of Magnet Ingestions at a Large Tertiary Care Children’s Hospital

Shaul

Agawu

Wood

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

View full text Add to dashboard Cite

show abstract

“…initial presentation. Clinically significant complications of multiple magnet ingestions may arise in up to one in 10 cases 4 while pediatric endoscopies can be done effectively and safely with a minor complication rate as low as 0.68%. 5 This risk-benefit equation favors early intervention whenever possible and is consistent with already published specialty guidelines.…”

Section: Discussionmentioning

confidence: 99%

Management patterns of multiple magnet ingestion reported to New Jersey Poison Information and Education System

Nguyen,

Calello,

Ruck

et al. 2023

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

BackgroundIngestion of multiple high‐powered neodymium rare‐earth magnets poses a significant risk for gastrointestinal (GI) injury such as bowel perforation or ischemia. Given the rising incidence of rare earth magnetic ingestions and the corresponding increase in serious injuries in children, published guidelines recommend urgent endoscopic removal of all magnets within endoscopic reach in cases involving ingestions of two or more magnets.Research QuestionDo management patterns for multiple magnet ingestion align with current practice guidelines, and does hospital length of stay (LOS) differ based on the initial emergency department (ED) approach?MethodsThis is a retrospective chart review of consecutive patient encounters reported to the New Jersey Poison Information and Education System (NJPIES) between January 2021 and April 2022 involving multiple magnet ingestion. Potential cases were retrieved from the NJPIES TOXICALL® database, using substance codes relating to magnet or foreign body ingestion. Two‐sample T tests were used to determine the statistical difference in the hospital LOS between the group of patients receiving early emergent esophagogastroduodenoscopy (EGD) versus those receiving expectant management on initial presentation.ResultsThere was a difference in the average LOS of 2.7 days (p = 0.023) longer in the expectant management group with no medical complications in either group. Twenty‐five percent or 2 out of 8 cases deviated from guidelines.ConclusionThe initial ED decision to pursue expectant management instead of attempting emergent EGD removal of magnets may result in prolonged hospitalization, increased risk for readmission, and delayed definitive removal of magnets due to nonprogression along the GI tract.

show abstract

“…After high‐powered magnet sets re‐entered the market, cases of magnet ingestion rebounded, more than doubling as reported at the Children’s Hospital of Philadelphia (6) and calls to poison centers increased by 444% nationwide (8). Not only did cases increase, but these cases were associated with significant morbidity and led to invasive interventions and hospitalizations (9).…”

mentioning

confidence: 99%