Severity of button batteries ingestions: data from French Poison Control Centres between 1999 and 2015

Labadie, Magali; O’Mahony, Elisabeth; Capaldo, Lise; Courtois, Arnaud; Lamireau, T.; Nisse, Patrick; Blanc-Brisset, Ingrid; Puskarczyk, Emmanuel

doi:10.1097/mej.0000000000000528

Cited by 33 publications

(29 citation statements)

References 19 publications

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“…Data from the U.S. National Electronic Injury Surveillance System analyzed from 1990 to 2009 have shown an increasing incidence of ED visits related to BB ingestions, reporting a child may present to the ED with a BB every 3 hours 23 . This trend has also been shown in analysis of French ED visits from 1999 to 2015 24 . With increasing incidence of BB ingestion, especially in the young population, an increase in morbidity and severe mortality is expected.…”

Section: Introductionmentioning

confidence: 87%

“…Furthermore, symptoms associated with BB ingestions are often vague and present similarly to common viral respiratory or gastrointestinal illnesses 39,40 . Finally, a majority of severe outcomes occur with unwitnessed ingestion and patients are often asymptomatic until a complication occurs 24,41 . Thus, the clinician is often presented with a challenging scenario and must rely on astute clinical investigation and radiographic imaging to obtain the diagnosis.…”

Section: Clinical Considerationsmentioning

confidence: 99%

“…It is important to predict, promptly detect, and treat potential severe complications that may be associated with BB ingestions. Reported complications include esophageal stenosis or perforation, mediastinitis, tracheoesophageal fistula (Figure 7), vocal cord paresis and paralysis, spondylodiscitis, intestinal perforation with peritonitis, cardiovascular and respiratory failure, pneumothorax, pneumoperitoneum, anterior spinal artery syndrome with bilateral lower extremity paralysis, vascular fistula leading to hemorrhage, and death 24,26,48 . According to the NCPC, 251 nonfatal BB ingestion cases with severe esophageal or airway injury have been reported 49 .…”

Section: Clinical Considerationsmentioning

confidence: 99%

“…According to the NCPC, 251 nonfatal BB ingestion cases with severe esophageal or airway injury have been reported 49 . Importantly, complications often present in a delayed fashion with bleeding events reported weeks after BB removal 1,24,50 . Other complications such as esophageal stricture and perforation, spondylodiscitis, and tracheoesophageal fistula have been reported to present weeks to months later with some cases as late as 6 to 8 months following BB ingestion 24,49 .…”

Section: Clinical Considerationsmentioning

confidence: 99%

“…With increasing incidence of BB ingestion, especially in the young population, an increase in morbidity and severe mortality is expected. Numerous reports have confirmed increasing incidence of the severity of BB ingestions 9,15,24 . This is likely attributed to an increase in more technologically advanced electronics in the household over the past two decades combined with the increase in production of the larger‐diameter, 3‐V lithium batteries in the marketplace 11,15,25 …”

Section: Introductionmentioning

confidence: 97%

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Current management of button battery injuries

Sethia

Gibbs

Jacobs

et al. 2021

Laryngoscope Investig Oto

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Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X‐ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child‐resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user‐friendly smartphone iOS/App Store and Android/GooglePlay application called the “GIRC App”; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life‐threatening injuries in children. Level of Evidence 5

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Section: Introductionmentioning

confidence: 87%

Section: Clinical Considerationsmentioning

confidence: 99%

Section: Clinical Considerationsmentioning

confidence: 99%

Section: Clinical Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 3 more Smart Citations

Current management of button battery injuries

Sethia

Gibbs

Jacobs

et al. 2021

Laryngoscope Investig Oto

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Airway Complications Resulting From Pediatric Esophageal Button Battery Impaction

Philteos

James

Propst

et al. 2022

JAMA Otolaryngol Head Neck Surg

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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.

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