J. Tashiro1, R. S. Kennedy1, E. A. Perez1, F. Mendoza2, J. E. Sola1 1University Of Miami,Division Of Pediatric Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA 2Baptist Children’s Hospital,Children’s Emergency Center,Miami, FL, USA
Introduction: Ingested foreign bodies are a frequent presentation in pediatric emergency departments. Although most will pass spontaneously through the gastrointestinal tract, the majority of esophageal foreign bodies (EFB) require removal. We analyzed hospital admissions for EFB to identify significant indicators for resource utilization in the U.S.
Methods: Kids’ Inpatient Database (1997-2009) was used to identify patients <20 yrs of age with EFB (ICD-9-CM 935.1). Multivariate logistic regression analyses (MVA) were constructed to identify predictors of resource utilization. Cases were weighted to project national estimates.
Results: Overall, 14,767 EFB cases were identified. Most patients were <5 years of age (72%), male (57%), and non-Caucasian (55%), with a median (IQR) length of stay of 1 (1) day, and total charges of 11,003 (8,505) USD. A total of 11,180 procedures were performed, most commonly esophagoscopy (77%), followed by bronchoscopy (20%), gastroscopy (2%), and rarely surgery (0.8%). A total of 5,826 patients (39% of the cohort) did not have an endoscopic procedure and were not transferred. Esophageal ulceration was the most common diagnosis, although caustic injury or esophageal perforation occurred infrequently (0.5% and 0.4%, respectively). By MVA, increased TC were associated with a diagnosis of esophageal ulceration (OR=1.72), esophagoscopy (OR=1.68), and bronchoscopy (OR=1.51), all p<0.001. TC also increased with admission to urban non-teaching hospitals (OR=1.45) vs. urban teaching hospitals, p<0.001. Large bedsize hospitals and facilities located in the Western U.S. had the highest TC vs. all others, p<0.001. Prolonged LOS (≥1 day) was associated with admission to non-children’s hospitals (OR=1.25) and children’s general hospitals (OR=1.22), as well as with esophageal ulceration (OR=2.19) and esophagoscopy (OR=1.11), p<0.05. Girls had higher odds of longer hospitalization (OR=1.19), p<0.001. Meanwhile, admission to small bedsize hospitals (OR=0.77) or facilities in the Western U.S. tended to decrease admission LOS, p<0.05. Overall hospital mortality was 0.1% (n=16).
Conclusion: Most EFB occur in children <5 years of age. Although surgery is rarely required, endoscopic removal of EFB is associated with increased TC and LOS. Surgeons should consider non-endoscopic removal techniques in witnessed and recent ingestions of blunt EFB such as coins. Hospital mortality is extremely rare in children with esophageal foreign bodies.
