The rate of children visiting the emergency department (ED) for battery exposure increased significantly from 2010 through 2017, and the majority of cases involved button batteries, a new study showed.
A related study looked at vascular injuries after button battery impaction in children and found most injuries resulted in death.
Battery-related ED visits
Authors of “Battery-Related Emergency Department Visits in the United States: 2010-2019” (Chandler MD, et al. Pediatrics. Aug. 29, 2022) obtained data from the National Electronic Injury Surveillance System, which uses a stratified probability-based sample of approximately 100 U.S. hospitals.
Data showed an estimated 70,322 ED visits related to cylindrical and button batteries occurred among children from Jan. 1, 2010, through Dec. 31, 2019, or about 9.5 per 100,000 children annually. Button batteries, which are small, disc-shaped cells, were implicated in 84.7% of visits where battery type was described. Ingestions accounted for 90% of ED visits, followed by nasal insertions (5.7%), ear insertions (2.5%) and mouth exposures (1.8%).
From 2010 through 2017, a significant increase in the ED visit rate occurred for youths under age 18 (from 7 to 14.3 per 100,000) and those ages 5 and under (from 16.8 to 38.4 per 100,000). There was a nonsignificant decrease in both age groups from 2017 to 2019.
The ED visit rate was highest among children ages 5 and younger compared to those 6-17 years (24.5 and 2.2 per 100,000 children, respectively).
Battery-related ED visits were most frequent among 1-year-olds than any other age.
The authors noted that button battery ingestions increased significantly during the first eight years of the study period due to increases among children ages 5 and younger.
These batteries are used to power consumer electronic devices, including toys, digital watches, hearing aids and remote controls. The batteries can be removed easily from devices. If swallowed, they can lodge in the esophagus and cause severe or life-threatening injuries.
Button battery manufacturers have introduced features to prevent ingestions, including child-resistant packaging, warning labels and nontoxic bitter coating on batteries. Use of bitterants, however, has not prevented ingestion of other hazardous items, so the efficacy of this approach has yet to be established.
“Despite all existing injury prevention efforts, battery-related ED visits remain too frequent,” authors wrote. “Regulatory efforts and adoption of safer button battery designs by industry to reduce or eliminate ingestion injuries in children are critically needed.”
Vascular complications after button battery ingestion
The authors of “Vascular Complications in Children Following Button Battery Ingestions: A Systemic Review” (Akinkugbe O, et al. Pediatrics. Aug. 29, 2022) summarized the literature on the prevalence, risk factors, presenting features, management and outcomes of vascular complications.
Using the National Capital Poison Center registry and PubMed database from inception to December 2021, they found 361 cases of button battery ingestion in children under 18 involving severe complications or death, 51 of which involved vascular injuries.
Most of the vascular complications were aorto-esophageal fistulae (75%) followed by subclavian artery fistulae (6%), carotid artery fistulae (4%) and thyroid artery fistulae (2%).
Eighty-one percent of vascular injuries led to death, and the median age of fatal cases was 24 months.
The median impaction time for fatal cases was 144 hours vs. 11 hours for nonfatal cases.
The most common presentations of vascular fistulae were hematemesis (75%), cardiac arrest (25%), hemorrhage (13%) and melaena (12%).
“Early recognition of ingestion and rapid coordination of transfer to a pediatric tertiary center for endoscopic removal of the button battery are essential to minimize duration of impaction,” authors wrote. “Survival is associated with shorter impaction times, reinforcing urgency to treat any patient presenting with delayed recognition or prolonged impaction as having an increased risk of serious complications.”
Limitations of the study include the small number of cases with vascular complications and lack of data on long-term morbidity for survivors.