Button-battery (BB) ingestion injuries have been reported in the peer-reviewed literature since 1990s. In 2012, Sharpe et al evaluated trends in BB ingestions from 1990 to 2009 and found an increase in the last 8 years of this study period. What has happened since 2009?
Chandler et al (10.1542/peds.2022-056709) share an analysis of BB emergency department (ED) visits in children <18 years from 2010-2019. The authors found that significant annual increases in BB ingestions continued to occur through 2017 followed by non-significant decreases. Most ED visits were for ingestions (90%), with insertions into the nose, ear, and mouth making up the remainder. The authors note that prevention efforts instituted over the past decade do not appear to be working. The discussion section of their study calls for advocating for greater regulatory efforts and better and safer BB designs by the industry to reduce access to these items by younger children and in turn the serious injuries that can result.
And speaking of serious injury, were you aware that exsanguination from vascular fistula formation can occur following a BB ingestion? Akinkugbe et al (10.1542/peds.2022-057477) from the Hospital for Sick Children in Toronto share with us the results of their systematic review of vascular complications following BB impaction in the gastrointestinal system. The authors looked at BB ingestion cases from the National Capital Poison Center Registry and PubMed database through December 2021 and found 361 cases of severe complications from BB ingestion, of which 19% were fatal and 14% involved vascular injuries. Three-quarters of these vascular injuries were aorto-esophageal fistulae and 82% of these patients did not survive. The authors identify factors found to be associated with fatal vascular BB ingestions—most notably duration of impaction being greater than 144 hours compared to cases whose impaction time was 96 hours or less and demonstrated better survival statistics. Akingube et al offer some suggestions for early identification of vascular complications. Put some energy into reading both of these articles so you are more charged up than ever when it comes to educating your patient and yourselves about the ongoing dangers of BB ingestions and what can be done to prevent serious complications.
