Foreign Body Injuries In Children Research Articles

Management of Pediatric Foreign Body Injuries during the COVID-19 Pandemic: Results of an International Survey.

The COVID-19 pandemic has had direct and indirect effects on daily life. In hospitals, the impact of the pandemic was observed in the diagnostic and therapeutic workflow. In this work, we explored potential changes in activities related to the treatment of foreign body injuries (FBIs) in children and the behavioral habits of physicians during the first wave of the pandemic. An online survey was conducted among physicians of the Susy Safe network. The survey comprised items related to respondent information, reference center characteristics, the treatment of FBIs during the COVID-19 pandemic, and a modified COVID-19 Anxiety Scale (CAS). The survey was distributed among the Susy Safe project international network surveillance registry for FBIs. A total of 58 physicians responded to the survey, including 18 (32%) from Europe and 16 (28%) from South America. The respondents indicated that the estimated number of aspirated foreign bodies during the pandemic was lower than or the same as that before the pandemic (43, 74%), and the same was observed for ingested foreign bodies (43, 74%). In univariable logistic regression, no single predictor was associated with a delay in routine care for children or an increasing tendency of medical personnel to avoid procedures. The workflow of physicians involved in the management of FBIs in children has not changed drastically during the COVID-19 pandemic, especially in emergency departments.

Management of Foreign Bodies in the Ear, Nose and Throat in Pediatric Patients: Real-Life Experience in a Large Tertiary Hospital.

Foreign body (FB) injuries occur frequently in children. The aim of this paper is to provide an update on the experience of the Department of Otolaryngology, San Camillo Forlanini Hospital in Rome concerning the management of FB injuries in children. This study was carried out by collecting data from the medical reports of our Pediatric Emergency Room stored between 2007 and 2021. Inclusion criteria were diagnosis of FB in pediatric patients based on the ENT evaluation. Pediatric patients included children and preteens ranging from six months to 15 years. Between 2007 and 2021, 1,623 cases of FBs in young patients (840 males, 783 females, mean age: 5.5 years) were observed at the Pediatric Emergency Room and treated by the ENT Department. The ear was the most frequently involved site (700 patients), followed by the nose (517 cases), pharynx (319 cases), mouth (76 patients) and airways (11 cases). The most common management strategy was FBs' removal in the emergency room and home discharge (1,409 patients), 99 cases required outpatient discharge, 64 patients moved away from the Emergency Care refusing treatment, 35 patients were hospitalized, 10 patients refused hospitalization, five were transferred to the pediatric hospital and one died in the emergency room. A quick diagnosis of FB followed by an effective removal is crucial to avoid injuries and complications. Surveillance registries have a key role in the prevention and management of FB injuries. Moreover, it is necessary to train medical and nursing staff of emergency, pediatric and otolaryngologist departments to best recognize and manage FB injuries.

Unsafe Chewing: Choking and Other Risks

Unsafe Chewing: Choking and Other Risks

Intraocular foreign body injury in children: clinical characteristics and factors associated with endophthalmitis

Background/AimsTo analyse the clinical characteristics of intraocular foreign body (IOFB) injury in children and evaluate factors associated with endophthalmitis development.MethodsPatients aged <18 years with IOFB attending Zhongshan Ophthalmic Center between...

Foreign Body injuries in children in India: Recommendations for prevention from a comparative analysis with international experience

ObjectivesThis study aims to identify specific patterns of risk in order to contribute to the prevention of Foreign Body (FB) injuries by assessing FB injury characteristics in Indian children. MethodsSingle center case series are included in the worldwide registry on Foreign Bodies Injuries www.susysafe.org. Statistical analysis performed on FB injury data (age, medical information, FB anatomical location (ICD) and characteristics, and situational data) from 252 Indian children (0–14 years) was used to identify FB risk patterns. ResultsThe study included 252 FB injury cases, out of which 110 occurred in females (43.7%). Most of the reported FB injuries (N = 252) were located in the mouth, esophagus and stomach, or intestines and colon (34.5%), and in the nose (31.3%). The analysis of the median duration of all injuries (i.e., the difference between the reported injury time/date and the reported time/date of arrival at hospital) showed that children with a FB in the airways were those referred to the hospital latest (median of 332.50 min, p-value <0.001). With regards to FB type, the majority of FB objects were non-food items and ingestion of coins accounted for 25% of all FB injuries. ConclusionsCultural differences may exist with regards to the Indian diet being conducive to lower choking food risk for children, and to acceptability and accessibility to objects such as coins and stationery. Such findings should be taken into account when developing primary and secondary prevention strategies aimed at reducing the burden of such injuries in India.

Austere Foreign Body Injuries in Children and Adolescents: A Characterization of Penile, Rectal, and Vaginal Injuries Presenting to Emergency Departments in the United States From 2008 to 2017.

Pediatric foreign body (FB) injuries to the nasal, aural, and/or oral cavities are well documented. Description of austere foreign body (AFB) injuries involving the rectum, vagina, or penis eludes the current pediatric literature. Austere FBs can be difficult to identify and have the potential to cause serious consequences. We aim to characterize AFB injuries by children and adolescents presenting to emergency departments (EDs) in the United States. The National Electronic Injury Surveillance System was queried to include subjects aged 0 to 25 years using a primary search term for diagnosis of foreign body from the period of January 2008 to January 2017. The consumer product and the body part involved (ie, rectal, vaginal, penile) were analyzed. Taylor series linearization generated national estimates. A trend analysis was performed using the Cochrane Armitage test of trend. There were 27,755 (95% confidence interval, 21,170-34,338) national estimated childhood ED visits for suspected AFB injuries during 2008 to 2017 including an estimated 7756 vaginal FBs, 7138 penile FBs, and 8359 rectal FBs (RFBs). Over the timeline, there was a significant up trend in the frequency of annual RFBs (P < 0.01). Austere FB injuries appear to cluster around age of 7 years. Most AFB injuries are able to be treated and released from the ED. It appears that RFB injury frequencies are rising and tend to require more frequent admission. Providers must be vigilant in the diagnosis and management of these potentially hazardous injury types.

Different anatomical sites of the foreign body injury with 2999 children during 2012–2016

PurposeThis study aimed to analyze the clinical characteristic of different foreign body injuries in children and offer the preventions. MethodsA retrospective study and the demographic information, injury causes, foreign body injury types and other clinical factors were recorded and analyzed. ResultsOf the 2999 patients, 1877 (62.6%) were boys and 1122 (37.4%) were girls. The majority (72.8%, n = 2184) of the injuries were found in 1–3 years old children. The most common anatomical site was the respiratory tract (73.4%, n = 2201) followed by the digestive tract (18.6%, n = 558), the genitourinary tract (1.93%, n = 58) and other sites (6.07%, n = 182). There were 60.4% of the in-patients from rural areas and 53.2% of the patients without medical insurance, the rate of cost by medical insurance increased with age. The medians of length of hospital stay and hospitalization cost were four days and 4767.3 CNY respectively. Most of the patients had surgical treatment (90.6%, n = 2717) and 64.9% of them had the complications (n = 1946). The cure rates of the all foreign body injuries types were above 90%, especially in genitourinary tract (98.3%). ConclusionDifferent types of the foreign body injuries had dissimilar clinical characteristics. The effective prevention and control measures should be taken according to the variety of high-risk population, incidence season and foreign body injury types.

Confirmed and Suspected Foreign Body Injuries in Children during 2008-2013: A Hospital-Based Single Center Study in Oulu University Hospital.

Foreign body injuries are common in children. Most of them are not serious but they can be fatal. A suspected foreign body injury in a child results in a high rate of hospitalizations, exposure to radiation, and need for intervention. This study aimed to analyze the current epidemiology of in-hospital or out of hospital treated foreign object injuries and suspected foreign body injuries in children. All children <16 years of age (N = 152) who suffered or were suspected to suffer (N = 63) from a foreign body injury and were treated in a pediatric trauma unit of Oulu University Hospital, Oulu, Finland, over a 6-year study period (2008-2013) were included. A comprehensive chart review was completed in order to evaluate injury history, age at the time of trauma, treatment and characteristics of the foreign objects. The majority (57.9%, N = 88) of the injuries were found in children <3 years of age. There was a male predominance (60.5%, N = 92). The most common anatomical site where the foreign body was found was the nose (28.9%, N = 44), followed by the esophagus (20.4%, N = 31) and the eye (11.2%, N = 17). Foreign objects were also found in the lower airways (10.5%, N = 16), ear (10.5%, N = 16), bowel (9.9%, N = 15), throat (3.9%, N = 6), stomach (3.9%, N = 6), and urethra (0.7%, N = 1). Various household items were the most common foreign bodies (33.6%, N = 51). Toys in particular caused 22.4% (N = 34) of the injuries. In-hospital intervention was necessary for 38.5% of the patients (N = 58). Intervention was needed in 39.7% (N = 25/63) of the patients who were suspected to suffer from foreign body but did not. There were no fatalities. Foreign body injuries treated at the pediatric trauma unit were most common in the youngest children (<3 years of age). Majority (61.8%, N = 94) of the patients were treated non-operatively, without any in-hospital intervention.

Foreign body injuries in children: Are the younger siblings doomed?

Background and objectivesForeign body injury (FBI) is a considerable public health issue for children. Although the relationships of FBI with age, gender, and objects of injury have been studied, the extent to which other demographic factors influence FBI is unclear. We hypothesized that the risk for FBI increases with the number of children in the household.Design and settingsThis was a retrospective analysis of 223 patients aged 2–10 years who presented to the emergency department of an inner-city pediatric hospital and who were found to have FBI.Patients and methodsThe guardians were contacted via phone to examine the associations of FBI with income, parental educational level, number of children in the household, and birth order while controlling with a matched population of 250 patients. Statistical analyses using frequencies and univariate and multivariate analyses were performed.ResultsFor each increase in the number of children, the risk of FBI increased 1.44-fold (OR = 1.442). With each increase in the number of caregivers, the risk of a FBI decreased 33% (OR = 0.673). With each increase in income category, the risk of a FBI decreased 59% (OR = 0.413).ConclusionThe results suggest that an increase in the number of children in a household is associated with a greater risk of FBI.

Upper aerodigestive magnetic foreign bodies in children

Small, powerful magnets are increasingly available in toys and other products, and are responsible for increasing numbers of foreign body injuries in children. Small, spherical, neodymium magnets available since 2008 are of particular concern. We aimed to identify all cases of upper aerodigestive foreign bodies at our institution over 15.5 years of study. Case series including all patients treated at an urban, tertiary care children's hospital who had upper aerodigestive magnetic foreign bodies, from January 1, 1998 through April 30, 2013. We manually reviewed 7,049 patient records abstracted from billing data to identify all patients 0 to 20 years of age who had upper aerodigestive magnetic foreign bodies. We identified four cases of upper aerodigestive magnetic foreign bodies, one involving the hypopharynx, and three involving the upper esophagus. Three occurred in 2010 or later. Two cases involve the ingestion of multiple, spherical, neodymium magnets recently marketed as desktop toys. In both of these cases, there was a rapid development of mucosal injury at the site of attraction between two magnets. As small, powerful magnets become more ubiquitous, pediatric magnet foreign body injuries are increasing. Although most are gastrointestinal, we identified four recent cases involving the upper aerodigestive tract. Multiple magnets lodged in the hypopharynx or esophagus can rapidly cause pressure necrosis of mucosal tissues, and merit prompt management. Education regarding magnet safety and improved magnet safety standards are needed to reduce the risk of these injuries. 4.

Comparing models for quantitative risk assessment: an application to the European Registry of foreign body injuries in children

Risk Assessment is the systematic study of decisions subject to uncertain consequences. An increasing interest has been focused on modeling techniques like Bayesian Networks since their capability of (1) combining in the probabilistic framework different type of evidence including both expert judgments and objective data; (2) overturning previous beliefs in the light of the new information being received and (3) making predictions even with incomplete data. In this work, we proposed a comparison among Bayesian Networks and other classical Quantitative Risk Assessment techniques such as Neural Networks, Classification Trees, Random Forests and Logistic Regression models. Hybrid approaches, combining both Classification Trees and Bayesian Networks, were also considered. Among Bayesian Networks, a clear distinction between purely data-driven approach and combination of expert knowledge with objective data is made. The aim of this paper consists in evaluating among this models which best can be applied, in the framework of Quantitative Risk Assessment, to assess the safety of children who are exposed to the risk of inhalation/insertion/aspiration of consumer products. The issue of preventing injuries in children is of paramount importance, in particular where product design is involved: quantifying the risk associated to product characteristics can be of great usefulness in addressing the product safety design regulation. Data of the European Registry of Foreign Bodies Injuries formed the starting evidence for risk assessment. Results showed that Bayesian Networks appeared to have both the ease of interpretability and accuracy in making prediction, even if simpler models like logistic regression still performed well.

Foreign Bodies Injuries in Children in Argentina: A Countrywide Program Connecting Evidence with Prevention

The present study presents 441 cases of foreign bodies (FB) injuries collected in Argentina, in the framework of the Susy safe program, a web-based surveillance registry for foreign body injuries in children aged 0-14. The analysis was carried out on hospital cases recorded for foreign bodies' injuries, registered in the Susy Safe database and validated as proper for quality and consistency of data. The current analysis is carried out on FBs located in ears, nose, pharynx and larynx, trachea, bronchi and lungs, mouth, oesophagus and stomach. Injuries occurred most frequently in children older than 3 years Four-hundred-forty-four cases were treated: female patient's incidence was lower than males' one, with a 1:1.24 proportion (44.7% of female, and 55.3% males). Analyzing the outcomes, hospitalization was required in 218 cases (49.5%), most frequently when the injury occurred in trachea, bronchi and lungs (36.4%). Complications were recorded in 49 patients (11.1%), the majority of which (5.7%) presented to the ENT departments with a FB in the respiratory system. An adult was present in 77.8 % of the cases testifying that primary prevention has a key role in avoiding those kinds of injuries. Particularly, active strategies that promote behavior change seem to be necessary. A communication initiative is under development in Argentina, aimed at informing parents and supervisors of the risks posed by common objects to their children's health.

Understanding the epidemiology of foreign body injuries in children using a data-driven Bayesian network

Bayesian networks (BNs) are probabilistic expert systems which have emerged over the last few decades as a powerful data mining technique. Also, BNs have become especially popular in biomedical applications where they have been used for diagnosing diseases and studying complex cellular networks, among many other applications. In this study, we built a BN in a fully automated way in order to analyse data regarding injuries due to the inhalation, ingestion and aspiration of foreign bodies (FBs) in children. Then, a sensitivity analysis was carried out to characterize the uncertainty associated with the model. While other studies focused on characteristics such as shape, consistency and dimensions of the FBs which caused injuries, we propose an integrated environment which makes the relationships among the factors underlying the problem clear. The advantage of this approach is that it gives a picture of the influence of critical factors on the injury severity and allows for the comparison of the effect of different FB characteristics (volume, FB type, shape and consistency) and children's features (age and gender) on the risk of experiencing a hospitalization. The rates it consents to calculate provide a more rational basis for promoting care-givers’ education of the most influential risk factors regarding the adverse outcomes.

Nuts and seed: A natural yet dangerous foreign body

Rationale and aimThis paper has the object to present the impact of nuts’ and seeds’ injuries withdrawing data from the Susy Safe registry, highlighting that as for other foreign bodies the main item efficiently and substantially susceptible to changes to decrease the accidents’ rates is the education of adults and children, that can be shared with parents both from pediatricians and general practitioners. Indeed labeling and age related warnings have also a fundamental relevance in prevention. MethodsThe present study draws its data from the Susy Safe registry. Details on injuries are entered in the Susy Safe Web-registry through a standardized case report form, that includes information regarding: children age and gender, features of the object, circumstances of injury (presence of parents and activity) and hospitalization's details (lasting, complications and removal details). Cases are prospectively collected using the Susy Safe system from 06/2005; moreover, also information regarding past consecutive cases available in each centre adhering to the project have been entered in the Susy Safe registry. ResultsNuts and seeds are one of the most common food item retrieved in foreign bodies injuries in children. In Susy Safe registry they represent the 38% in food group, and almost the 10% in general cases. Trachea, bronchi and lungs were the main location of FB's retrieval, showing an incidence of 68%. Hospitalization occurred in 83% of cases, showing the major frequency for foreign bodies located in trachea. This location was also the principal site of complications, with a frequency of 68%. There were no significant associations between these outcomes and the age class of the children. The most common complications seen (22.4%) was bronchitis, followed by pneumonia (19.7%). Adult presence was recorded as positive in 71.2% of cases, showing an association (p value 0.009) between the adult supervision and the hospitalization outcome. On the contrary there was a non significant association between adult presence and the occurrence of complications. In 80.7% of cases, the incident happened while the child was eating. Among those cases, 88.6% interested trachea, lungs and bronchi. ConclusionsFood-related aspiration injuries are common events for young children, particularly under 4 years of age, and may lead to severe complication.There is a need to study in more depth specific characteristics of foreign bodies associated with increased hazard, such as size, shape, hardness or firmness, lubricity, pliability and elasticity, in order to better identify risky foods, and more precisely described the pathogenetic pathway. Parents are not adequately conscious and aware toward this risk; therefore, the number and severity of the injuries could be reduced by educating parents and children. Information about food safety should be included in all visits to pediatricians in order to make parents able to understand, select, and identify key characteristics of hazardous foods and better control the hazard level of various foods. Finally, preventive measures including warning labels on high-risk foods could be implemented.

Foreign bodies injuries in children: Analysis of Thailand data

ObjectivesSuffocation due to foreign bodies (FB) is a leading cause of death in children aged 0–3 and it is common also in older ages, up to 14 years old. Based on the RPA report the estimated number of incidents per year in children aged 0–14 is in European Union (EU) of approximately 50,000, 10% of which are fatal. The need of an improvement of knowledge led to the development of the pan European study ESFBI (European Survey on Foreign Bodies Injuries) that collected data on FB injuries in the aerodigestive tract in paediatric patients from 19 European Hospitals (Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Germany, Greece, Italy, Poland, Romania, Slovakia, Slovenia, Spain, Sweden, Swiss, Turkey and United Kingdom). Recognizing that the rapid management is one of the main goals in the presence of such injury the aim of this paper is to confront data coming from 4 ESFBI case series with a Thailand's case series, in order to broaden the knowledge on FBs injuries characteristics, knowing that features like shape, dimension, consistency are fundamental in determine the consequences that might occur. MethodsData coming from the Siriraj Hospital, Thailand from June 2006 to 2010 were collected and compared with 4 case series chosen amongst the ESFBI study cases (Finland, Slovenia, Sweden and Turkey). Results172 cases were collected from the Siriraj Hospital in Bangkok, Thailand. The chosen ESFBI members were Finland, Sweden, Slovenia and Turkey, with a sample numerosity respectively of 307, 235, 104 and 196 cases. All countries showed a male prevalence higher than the female one, and injuries occurred most frequently in children younger than 3 years old. The most frequent retrieval location was the digestive system (oesophagus) in Thailand data (97 cases, 56.40% of cases), whilst European cases involved more frequently the nose in Slovenia (58.65%), Finland (37.79% of cases) and Sweden (54.47%). In Turkey's case series, the highest prevalence of cases interested the airways. In Thailand and Finland case series, the main FB's type were represented by bones (respectively 66 case, 38.37% and 48 cases, 15.64%), whilst pearl, ball and marble were the most frequent FB both in Slovenia (16, 15.38%) and Sweden (83, 35.32%). Turkey case series had nuts, seeds and grain as most prevalent FB (126, 64.29%). ConclusionsThe nature of foreign bodies varies from country to country and is dependent on diverse cultural, social, religious and economic factors that include parental attitudes, eating habits, availability and types of potentially threatening objects, and prevention strategies. The need to study in more depth specific characteristics of foreign bodies associated with increased hazard, such as nature, size, shape, hardness or firmness, lubricity, pliability and elasticity, in order to better identify risky foods and to describe more precisely the pathogenetic pathway is therefore a necessity.

Retrospective study on Romanian foreign bodies injuries in children

BackgroundForeign bodies (FB) injuries are an issue that has been recognized and investigated since many years; despite that, the impact of this subject in literature and research is still small. Such kind of injuries identifies all incidents due to ingestion, inhalation, insertion and aspiration of an object into the aero digestive tract. FBs injuries located in the upper airways can be a very serious event, sometimes resulting in fatal outcome. MethodsA retrospective study was performed on FB injuries in the aerodigestive tract in paediatric patients 1–17 years old, recorded from the ENT Department of the M. S. Curie Hospital in Bucharest. Results455 cases were reported from the M. S. Curie Hospital, ENT Department. Prevalence in female patients is higher than the males (225 males and 230 females). Mean age observed was 4.12 years. The distribution of injuries according to the retrieval location showed a higher prevalence in the nose (44.62% of cases), with a higher occurrence in females (50.74%) followed by the digestive system (24.28% of cases) were the distribution between males and females is equal. The highest prevalence was represented by nuts and seed (23.96%), followed by marble and coins (respectively 12.75% and 12.53%). ConclusionsAs generally described in scientific literature, injuries usually concerned toddlers and preschoolers, while school-aged children less often place foreign objects in their noses. Our results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behaviour change are necessary. Active strategies require that a caregiver changes his or her behaviour each time the child begins an activity that has the potential to cause injury. Education is critical to these active strategies and plays a complementary role to environmental changes and legal mandates.

Rare presentation of a wooden foreign body in the thigh.

Children are prone to injury with foreign bodies, partly due to their ebullient nature. They may not always give an accurate history, which can lead to delay in diagnosis and treatment. Primary care givers need to be vigilant in eliciting a history of foreign body injury in children. Radiologists should be aware that a neglected foreign body lying close to the bone in the distal femur can evoke a massive periosteal reaction, which can mimic a bone neoplasm. Although metallic foreign bodies are detected with ease on radiographs, detection of wooden foreign bodies remains a challenging task for both the radiologist and the care-giving physician. Wood foreign bodies may induce errors in diagnosis. The paper includes an analysis of the different radiographic methods currently available and their main features. This report would be of relevance to primary care physicians, those concerned with trauma care, and for radiologists who screen for these injuries.

Foreign body injuries in children: need for a step forward against an old yet neglected epidemic

Foreign body injuries in children: need for a step forward against an old yet neglected epidemic

Comparing Bayesian network, artificial neural networks, classification trees and classical logistic models in quantitative risk assessment: an application to the European Registry of Foreign Body Injuries in Children

Risk assessment is the systematic study of decisions subject to uncertain consequences.An increasing interest has been focused on modelling techniques like Bayesian networks (BNs) since their capability of (1) combining...

Adaptive Bayesian Networks for quantitative risk assessment of foreign body injuries in children

Injuries due to foreign body (FB) aspiration/ingestion/insertion represent a common public health issue in paediatric patients, which causes significant morbidity and mortality. The aim of this study is to present a Bayesian Network (BN) model for the identification of risk factors for FB injuries in children and provide their quantitative assessment. Combining a priori knowledge and observed data, a BN learning algorithm was used to generate the pattern of the relationships between possible causal factors of FB injuries. Finally, the BN was used for making inference on scenarios of interest, providing, for instance, the risk that an accident caused by a spherical object swallowed by a male child aged five while playing leads to hospitalization. BNs as a tool for quantitative risk assessment may assist in determining the hazard of consumer products giving an insight into their most influential specific features on the risk of experiencing severe injuries.