Risk Factors Associated with Endoscopic Intervention in Pediatric Patients Presenting with Foreign Body Ingestion to the Emergency Department

TL;DR

This study examines factors influencing endoscopic intervention in children who ingest foreign objects, finding that high-risk criteria and coin ingestion are key predictors.

Contribution

The study identifies coin ingestion as a potential high-risk factor for endoscopy in pediatric foreign body cases.

Findings

Established high-risk criteria strongly predict endoscopic intervention (adjusted OR ≈ 179.4).

Coin ingestion is independently associated with endoscopy compared to button batteries (adjusted OR ≈ 7.26).

Most endoscopies involved coins, button batteries, or magnets, with a 74.5% success rate.

Abstract

Background/Objectives: Pediatric foreign body (FB) ingestion is a common clinical problem that frequently necessitates time-sensitive decisions regarding esophagogastroduodenoscopy (EGDS). Although established high-risk criteria guide the indication for EGDS, coins—despite their high prevalence—are not uniformly classified as high-risk FBs. In this study, we aimed to delineate epidemiology and endoscopic outcomes and to identify predictors of EGDS. Methods: We retrospectively reviewed cases of children younger than 15 years presenting to an urban emergency department (ED) with suspected or confirmed FB ingestion between 2014 and 2020. After applying exclusion criteria, 757 patients remained for analysis. Data abstracted included demographic characteristics, presenting symptoms, type and location of FB, ED length of stay (EDLOS), and whether EGDS was performed along with its outcomes. Multivariable logistic regression was used to identify predictors of EGDS, including age group, sex, symptom presence, established high-risk criteria, and type of FB (coin, button battery, magnet). Results: Among 757 children (median age 17.0 months; 54.0% male), 55.2% were asymptomatic. EGDS was performed in 47 of the 757 children (6.2%), with a success rate of 74.5% (35/47). Among EGDS cases, the most common foreign bodies were coins (29.8%), button batteries (27.7%), and magnets (17.0%). In multivariable models, established high-risk criteria were the dominant determinant of EGDS (adjusted OR ≈ 179.4; 95% CI, 29.9–1075.8; p < 0.001). Compared with button batteries, coin ingestion was independently associated with EGDS (adjusted OR ≈ 7.26; 95% CI, 1.07–49.31; p = 0.042). Conclusions: Established high-risk criteria were the primary determinant of EGDS, and coin ingestion showed a possible independent association with EGDS; these findings suggest that coin ingestion may warrant consideration as a potential high-risk factor when determining whether endoscopy is indicated.

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