Battery Algorithm Libertin
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Key Takeaways
- Batteries past the esophagus can be managed conservatively if patient is asymptomatic—monitor 5-7 days with imaging before intervention.
- Urgent removal required for esophageal batteries or symptomatic patients regardless of battery location.
- Most batteries passing the GE junction pass spontaneously without complications when managed expectantly.
- Intervene earlier if battery fails to progress after 5-7 days or if co-ingestion of magnets or other concerning items.
- Evidence-based algorithms reduce unnecessary surgical interventions and standardize care across providers.
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Transcript
This is Todd Ponsky from The Journal of Pediatric Surgery, and here's your two minute review. Today we have a special treat. We actually have a medical student doing our two minute review. This is Maria Libertin who's a first year medical student at NEOmed here in Northeast Ohio. Maria's gonna review an article on battery ingestion that was just published in The Journal of Pediatric Surgery. Maria? Battery ingestion is very common in pediatric patients. And while it is known to urgently remove a battery within the esophagus, the treatment plan becomes a little bit more inconsistent when it's passed the gastroesophageal junction. Therefore, authors Eric Rosenfeld and Sohail Shah looked more into the whole entire process of what we do when the battery is passed that junction. They published the paper, Battery Ingestion in Children: Variations in Care and Development of Clinical Algorithms. This was a two center study done at Texas Children's and Children's Mercy Hospital in Kansas City. After retrospective review and a literature review, they created an evidence based algorithm to create more consistency among providers when treating this condition. Their retrospective study showed a majority of battery ingestions pass the esophagus were treated conservatively with no intervention and had no complications. Those that were treated with an interventions were either symptomatic, unable to pass the battery within an appropriate amount of time, or had other concerning ingested items such as magnets. The retrospective study also showed two patients needing intervention when the battery was passed the esophagus, but these were patients that had ingested button batteries with a perforated Meckel's diverticulum and a gastric perforation. Their evidence based algorithm simply states that if the patient's asymptomatic, you need to urgently remove the battery. If the patient is asymptomatic, they should be monitored for five to seven days with imaging. And then if the battery shows no progression, then the physician should start considering removing the battery. This is also a simplified version of the algorithm found on poison.org for which the link is found below. This study will hopefully eliminate the amount of unnecessary surgical intervention and increase the consistency in the treatment among all medical professionals when dealing with battery ingestions in pediatric patients. Maria awesome job, great review. Um let me just try to summarize this. Uh we know that we remove the batteries from the esophagus. We don't all agree on what to do when they've gone into the stomach. The gist here is if they're asymptomatic, you can send them home, get the x-rays as an outpatient. and after seven days if it's still there then intervene. Uh if they're symptomatic you admit them to the hospital and intervene, right? Um there's two algorithms, again we're posting them both. There's the one from this study and then there's the one from poison.org and we'll have both of those algorithms here. Thank you for a great review. Thank you.