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. 2022 Feb 1;74(2):236-243.
doi: 10.1097/MPG.0000000000003346.

Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care

Elizabeth M Sinclair  1 , Matthew T Santore  2 , Maneesha Agarwal  3 , Jamie Kitzman  4 , Cary G Sauer  1 , Erica L Riedesel  5
Affiliations

Evolving Clinical Care in Esophageal Button Batteries: Impact of Expert-Opinion Guideline Adoption and Continued Gaps in Care

Elizabeth M Sinclair et al. J Pediatr Gastroenterol Nutr. .

Abstract

Background/objectives: Esophageal button battery impactions (BBI) in children pose a significant danger to children. Although there are expert-opinion guidelines to help manage this population, few studies detail the impact of guidelines on the clinical care of these patients. With this study, we aimed to describe the care of these patients before and following adoption of guidelines at a single center.

Methods: Retrospective cohort study of patients with esophageal BBI at a single center, large volume, urban academic pediatric hospital system before adoption of expert-opinion guidelines (2007-2017) and following adoption (2018-2020).

Results: Cohort was comprised of 31 patients before adoption and 32 patients following adoption of guidelines. Patient characteristics did not differ between groups. After 2018, significantly more patients received acetic acid irrigation, initial cross-sectional imaging, and serial cross-sectional imaging. There was also an increase in intensive care unit (ICU) stays, number of intubations, nil per os time, and hospital length of stay. There was no difference in patient outcomes.

Conclusion: This study describes a large cohort of pediatric esophageal BBI before and following adoption of guidelines. Findings detail increased adherence to guidelines resulting in more cross-sectional imaging which led to ICU stays, longer length of stays, and more nil per os time. This study emphasizes the need for multi-disciplinary guidelines as well as further multi-institutional study.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:. Comparison of Expert-Opinion Guidelines.
Key aspects of managing patients with esophageal BBI are compared across available guidelines and show evolution over time as new evidence became available.
Figure 2:
Figure 2:. Continued Gaps in Management.
Summary list of areas that need more evidence-based guidelines and multidisciplinary collaboration
See this image and copyright information in PMC

References

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