Main theme: General
Introduction
Button battery (BB) ingestion in children is a rare but time-critical emergency with potentially fatal complications. In oesophageal impaction, emergency removal in theatre is paramount, however at the time of writing there is no gold-standard Ear, Nose and Throat (ENT) nor paediatric consensus on primary interventions and peri-operative management. The use of oral sucralfate, nasogastric tube (NGT) insertion and post-removal imaging differs significantly between centres. To standardise peri-operative care, we have designed and successfully implemented an evidence-based regional management protocol within the West Midlands.
Methods
A survey was distributed to ENT consultants ascertaining regional variation in practice. The survey enquired whether ingested BBs were removed on-site or transferred to a tertiary unit, and peri-operative measures taken. Whether a standardised protocol would be beneficial, was included. Recommendations in a European Paediatric position paper were evaluated. [1]
Results
5.9% of consultants (n = 17) agreed that a regional consensus currently existed. 82.4% strongly agreed a regional protocol would positively impact clinical outcomes. Accordingly, a comprehensive protocol was designed, with a management flowchart incorporating BB location, clinical stability, and logistics for inter-hospital transfer. Sucralfate administration, NGT insertion, acetic acid irrigation, antibiotic prophylaxis and post-removal imaging guidelines were included.
Conclusion
Following promising consultant stakeholder support, a comprehensive, standardised evidence-based emergency management protocol for paediatric BB ingestion has been implemented regionally. Since, real-world application of the protocol has been demonstrated following a case of BB ingestion managed with successful outcome. Review of prospective multi-regional data will guide the path ahead.
References
[1] European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2021. Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology, Hepatology and Nutrition Position Paper. [Online].