Pre-hospital triage of children at risk of oesophageal button battery impaction: the button battery impaction score

Abstract

Introduction

Button battery ingestion in children can be fatal if oesophageal perforation occurs. Such children require chest radiography in the emergency department to determine the button battery position and number. Current guidelines recommend that a button battery impacted in the oesophagus should be removed within two hours. We developed a clinical tool (the button battery impaction score) to estimate the risk of oesophageal impaction and help determine the most appropriate healthcare facility for initial assessment, either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval.

Methods

A multi-centre retrospective study was conducted over seven years in eight French poison centres. We included patients aged less than 12 years with radiography showing the button battery position and a symptom description before radiography. Button battery impaction scores were calculated using backward stepwise selection.

Results and discussion

A total of 1,430 patients were included, of whom 86, 461, and 375 had a button battery in their oesophagus, stomach, and post-pyloric position, respectively. No button batteries were identified by radiography in 508 patients. Sixteen of thirty-five factors independently predicted oesophageal impaction before chest radiography (P < 0.05). After the backward stepwise selection, the following seven factors contributed to the button battery impaction score: cough, drooling, dysphagia/food refusal, fever, pain (unspecified location), vomiting, and button battery ≥ 15 mm. The button battery impaction score showed an area under the curve value of 0.87, a negative predictive value of 0.98, and a sensitivity of 0.86. No cases of death, stricture, or haemorrhage were observed in patients with negative scores, including those with oesophageal impaction.

Conclusions

A button battery impaction score used readily available data to predict the risk of oesophageal impaction after button battery ingestion and before chest radiography. When further validated, this rapid tool may be widely applicable in determining an appropriate facility for patient transfer to either a local medical centre or a medical centre with the infrastructure for endoscopic retrieval.

Keywords:

• Foreign body
• children
• oesophageal injury
• paediatric emergency medicine
• emergency medical service

Acknowledgment

The authors would like to thank the secretaries, nurses, pharmacists and physicians who work in French poison centres and who support the completion of studies such as this one.

Ethical approval

Individual patient consent was not required, according to French law regarding retrospective research conforming to the norm MR-003 (JORF no. 0160 du 13 juillet 2018. texte no. 109). The database of this study has been registered at the Commission National de l‘Informatique et des Libertés (registration No. 747735), in compliance with French law on electronic data sources.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors contribution

Dr Jules-Antoine Vaucel, and Dr Cédric Gil-Jardine conceptualized and designed the study, designed the data collection instruments, carried out the initial analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. Dr Camille Paradis and Dr Raphael Enaud performed the acquisition of data collection; critically reviewed and revised the manuscript. Dr Labadie conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All main authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Additional information

Funding

The authors reported there was no funding associated with the work featured in this article.